Common use of Covered California for Small Business Participation Fees Clause in Contracts

Covered California for Small Business Participation Fees. (a) Contractor understands and agrees that (i) under the Affordable Care Act and the California Affordable Care Act, Covered California may generate funds through a participation fee (“Participation Fees”) on Contractor’s QDPs and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. Covered California shall collect Participation Fee and Agent and General Agent compensation from premiums remitted by Employers and Employees. (b) The Participation Fee payable to Covered California during each month of this Agreement shall be equal to five point two (5.2) percent of the gross premium attributable to each Enrollee in Contractor’s QDPs for such month plus additional fees as necessary to support distribution related expenses. The Participation Fee will be assessed by Covered California and payable monthly by Contractor based on premium attributable to enrollees in Contractor’s QDPs sold through the Covered California for Small Business for 2017-2022. The Participation Fee will be reviewed each year as part of the Covered California’s annual budget process. Should Covered California need to collect or refund any premiums for years 2014 to 2016, the Participation Fee shall be calculated pursuant to the QDP Issuer Agreement that was in place during the applicable plan year or years. (c) With respect to Covered California for Small Business, Contractor acknowledges that (i) Covered California is responsible for collecting premiums from Employers and Employees, and (ii) Covered California will remit applicable Employer and Employee premiums collected by Covered California to Contractor, net of (1) Participation Fees computed in accordance with the Participation Methodology - Covered California for Small Business, and (2) Distribution related expenses determined in accordance with the terms set forts at Sections 2.3.3 and 2.3.6. Covered California for Small Business shall transfer funds to Contractor on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor and shall establish a process to resolve any disagreements on premium amounts due in a timely manner and prior to transfer of funds to Contractor as required under this section. (d) In the event that Contractor disputes the amount of Participation Fees billed or deducted by Covered California, Contractor shall submit a written notice of such dispute to the Covered California within thirty (30) days following receipt of such bill or deduction by Covered California. Contractor’s notice will document the nature of the discrepancies, including reconciliation of any differences identified by Contractor in enrollment or premiums collected. Covered California will respond to Contractor within forty-five (45) days of receipt of the notice by either (i) paying the amount claimed by Contractor or (ii) providing a detailed explanation for the denial of the refund. If the Contractor still disputes the findings of Covered California, Contractor may pursue additional remedies in accordance with Section 12.1. (e) Subject to the provisions of Section 10.5, Contractor agrees to a periodic audit or other examination by Covered California or its designee regarding the computation and payment of Participation Fees. In the case of material non-compliance with Participation Fee payments, Contractor shall implement any necessary corrective action and follow up audits or examinations may be performed by Covered California more frequently than annually to monitor Contractor’s implementation of such corrective actions. (f) Contractor acknowledges that Covered California is required under Government Code § 100520(c) to maintain a prudent reserve as determined by Covered California.

Covered California for Small Business Participation Fees. (a) Contractor understands and agrees that (i) under the Affordable Care Act and the California Affordable Care Act, Covered California the Exchange may generate funds through a participation fee (“Participation Fees”) on Contractor’s QDPs and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered Californiathe Exchange. Covered California The Exchange shall collect Participation Fee and Agent and General Agent compensation from premiums remitted by Employers and Employees. (b) The Participation Fee payable to Covered California the Exchange during each month of this Agreement shall be equal to five point two (5.2) 5.2 percent of the gross premium attributable to each Enrollee in Contractor’s QDPs for such month plus additional fees as necessary to support distribution related expensespay Agent commissions. The Participation Fee will be assessed by Covered California the Exchange and payable monthly by Contractor based on premium attributable to enrollees in Contractor’s QDPs sold through the Covered California for Small Business Exchange for 2017-20222019. The Participation Fee will be reviewed each year as part of the Covered CaliforniaExchange’s annual budget process. Should Covered California the Exchange need to collect or refund any premiums for years 2014 to 2016, the Participation Fee shall be calculated pursuant to the QDP Issuer Agreement that was in place during the applicable plan year or years. (c) With respect to Covered California for Small Business, Contractor acknowledges that (i) Covered California the Exchange is responsible for collecting premiums from Employers and Employees, and (ii) Covered California the Exchange will remit applicable Employer and Employee premiums collected by Covered California the Exchange to Contractor, net of (1) Participation Fees computed in accordance with the Participation Methodology - Covered California for Small Business, and (2) Distribution related expenses determined in accordance with the terms set forts forth at Sections 2.3.3 and Section 2.3.6. Covered California for Small Business shall transfer funds to Contractor on a monthly basis or such other intervals as mutually agreed upon by Covered California the Exchange and Contractor and shall establish a process to resolve any disagreements on premium amounts due in a timely manner and prior to transfer of funds to Contractor as required under this sectionSection. (d) In the event that Contractor disputes the amount of Participation Fees billed or deducted by Covered Californiathe Exchange, Contractor shall submit a written notice of such dispute to the Covered California Exchange within thirty (30) days following receipt of such bill or deduction by Covered Californiathe Exchange. Contractor’s notice will document the nature of the discrepancies, including reconciliation of any differences identified by Contractor in enrollment or premiums collected. Covered California The Exchange will respond to Contractor within forty-five (45) days of receipt of the notice by either (i) paying the amount claimed by Contractor or (ii) providing a detailed explanation for the denial of the refund. If the Contractor still disputes the findings of Covered Californiathe Exchange, Contractor may pursue additional remedies in accordance with Section 12.1. (e) Subject to the provisions of Section 10.5, Contractor agrees to a periodic audit or other examination by Covered California the Exchange or its designee regarding the computation and payment of Participation Fees. In the case of material non-compliance with Participation Fee payments, Contractor shall implement any necessary corrective action and follow up audits or examinations may be performed by Covered California the Exchange more frequently than annually to monitor Contractor’s implementation of such corrective actions. (f) Contractor acknowledges that Covered California the Exchange is required under Government Code § §100520(c) to maintain a prudent reserve as determined by Covered Californiathe Exchange.

Covered California for Small Business Participation Fees. (a) Contractor understands and agrees that (i) under the Affordable Care Act and the California Affordable Care Act, Covered California may generate funds through a participation fee (“Participation Fees”) on Contractor’s QDPs and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. Covered California shall collect Participation Fee and Agent and General Agent compensation from premiums remitted by Employers and Employees. (b) The Participation Fee payable to Covered California during each month of this Agreement shall be equal to five point two (5.2) percent of the gross premium attributable to each Enrollee in Contractor’s QDPs for such month plus additional fees as necessary to support distribution related expenses. The Participation Fee will be assessed by Covered California and payable monthly by Contractor based on premium attributable to enrollees in Contractor’s QDPs sold through the Covered California for Small Business for 2017-202220212022. The Participation Fee will be reviewed each year as part of the Covered California’s annual budget process. Should Covered California need to collect or refund any premiums for years 2014 to 2016, the Participation Fee shall be calculated pursuant to the QDP Issuer Agreement that was in place during the applicable plan year or years. (c) With respect to Covered California for Small Business, Contractor acknowledges that (i) Covered California is responsible for collecting premiums from Employers and Employees, and (ii) Covered California will remit applicable Employer and Employee premiums collected by Covered California to Contractor, net of (1) Participation Fees computed in accordance with the Participation Methodology - Covered California for Small Business, and (2) Distribution related expenses determined in accordance with the terms set forts at Sections 2.3.3 and 2.3.6. Covered California for Small Business shall transfer funds to Contractor on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor and shall establish a process to resolve any disagreements on premium amounts due in a timely manner and prior to transfer of funds to Contractor as required under this section. (d) In the event that Contractor disputes the amount of Participation Fees billed or deducted by Covered California, Contractor shall submit a written notice of such dispute to the Covered California within thirty (30) days following receipt of such bill or deduction by Covered California. Contractor’s notice will document the nature of the discrepancies, including reconciliation of any differences identified by Contractor in enrollment or premiums collected. Covered California will respond to Contractor within forty-five (45) days of receipt of the notice by either (i) paying the amount claimed by Contractor or (ii) providing a detailed explanation for the denial of the refund. If the Contractor still disputes the findings of Covered California, Contractor may pursue additional remedies in accordance with Section 12.1. (e) Subject to the provisions of Section 10.5, Contractor agrees to a periodic audit or other examination by Covered California or its designee regarding the computation and payment of Participation Fees. In the case of material non-compliance with Participation Fee payments, Contractor shall implement any necessary corrective action and follow up audits or examinations may be performed by Covered California more frequently than annually to monitor Contractor’s implementation of such corrective actions. (f) Contractor acknowledges that Covered California is required under Government Code § 100520(c) to maintain a prudent reserve as determined by Covered California.

Covered California for Small Business Participation Fees. (a) Contractor understands and agrees that (i) under the Affordable Care Act and the California Affordable Care Act, Covered California may generate funds through a participation fee (“Participation Fees”) Fees on Contractor’s QDPs QHPs and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. Covered California shall collect Participation Fee and Agent and General Agent compensation distribution related expenses from premiums remitted by Employers and Employees. (b) The Contractor recognizes that the total cost of all Participation Fee payable to Fees for Covered California during each month of this Agreement shall must be equal to five point two (5.2) percent of the gross premium attributable to each Enrollee in spread across Contractor’s QDPs for such month plus additional fees as necessary to support distribution related expenses. The Participation Fee will be assessed by Covered California entire book of business in the single risk pool (both inside and payable monthly by Contractor based on premium attributable to enrollees in Contractor’s QDPs sold through the Covered California for Small Business for 2017-2022. The Participation Fee will be reviewed each year as part of the outside Covered California’s annual budget process. Should Covered California need to collect or refund any premiums ) for years 2014 to 2016, the Participation Fee shall be calculated pursuant to the QDP Issuer Agreement that was in place during the applicable plan year or yearssmall employer market. (c) With respect to Covered California for Small Business, Contractor acknowledges that (i) Covered California is responsible for collecting premiums from Employers and Employees, and (ii) Covered California will remit applicable Employer and Employee premiums collected by Covered California to Contractor, net of (1) Participation Fees computed in accordance with the Participation Methodology - Covered California for Small Business, and (2) Distribution related expenses determined in accordance with the terms set forts forth at Sections 2.3.3 2.2.3 and 2.3.63.3. Covered California for Small Business shall transfer funds to Contractor on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor and shall establish a process to resolve any disagreements on premium amounts due in a timely manner and prior to transfer of funds to Contractor as required under this sectionSection. (d) In the event that Contractor disputes the amount of Participation Fees billed or deducted by Covered California, Contractor shall submit a written notice of such dispute to the Covered California within thirty (30) days Days following receipt of such bill or deduction by Covered California. Contractor’s notice will document the nature of the discrepancies, including including, reconciliation of any differences identified by Contractor in enrollment or premiums collected. Covered California will respond to Contractor within forty-five (45) days Days of receipt of the notice by either (i) paying the amount claimed by Contractor or (ii) providing a detailed explanation for the denial of the refund. If the Contractor still disputes the findings of Covered California, Contractor may pursue additional remedies in accordance with Section 12.1. (e) Subject to the provisions of Section 10.5, Contractor agrees to a periodic audit or other examination by Covered California or its designee regarding the computation and payment of Participation Fees. In the case of material non-compliance with Participation Fee payments, Contractor shall implement any necessary corrective action and follow up audits or examinations may be performed by Covered California more frequently than annually to monitor Contractor’s implementation of such corrective actions. (f) Contractor acknowledges that Covered California is required under Government Code § 100520(c) to maintain a prudent reserve as determined by Covered California.or

Covered California for Small Business Participation Fees. (a) Contractor understands and agrees that (i) under the Affordable Care Act and the California Affordable Care Act, Covered California the Exchange may generate funds through a participation fee (“Participation Fees”) on Contractor’s QDPs and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered Californiathe Exchange. Covered California The Exchange shall collect Participation Fee and Agent and General Agent compensation from premiums remitted by Employers and Employees. (b) The Participation Fee payable to Covered California the Exchange during each month of this Agreement shall be equal to five point two (5.2) percent of the gross premium attributable to each Enrollee in Contractor’s QDPs for such month plus additional fees as necessary to support distribution related expenses. The Participation Fee will be assessed by Covered California the Exchange and payable monthly by Contractor based on premium attributable to enrollees in Contractor’s QDPs sold through the Covered California for Small Business Exchange for 2017-20222020. The Participation Fee will be reviewed each year as part of the Covered CaliforniaExchange’s annual budget process. Should Covered California the Exchange need to collect or refund any premiums for years 2014 to 2016, the Participation Fee shall be calculated pursuant to the QDP Issuer Agreement that was in place during the applicable plan year or years. (c) With respect to Covered California for Small Business, Contractor acknowledges that (i) Covered California the Exchange is responsible for collecting premiums from Employers and Employees, and (ii) Covered California the Exchange will remit applicable Employer and Employee premiums collected by Covered California the Exchange to Contractor, net of (1) Participation Fees computed in accordance with the Participation Methodology - Covered California for Small Business, and (2) Distribution related expenses determined in accordance with the terms set forts at Sections 2.3.3 and 2.3.6. Covered California for Small Business shall transfer funds to Contractor on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor and shall establish a process to resolve any disagreements on premium amounts due in a timely manner and prior to transfer of funds to Contractor as required under this section. (d) In the event that Contractor disputes the amount of Participation Fees billed or deducted by Covered California, Contractor shall submit a written notice of such dispute to the Covered California within thirty (30) days following receipt of such bill or deduction by Covered California. Contractor’s notice will document the nature of the discrepancies, including reconciliation of any differences identified by Contractor in enrollment or premiums collected. Covered California will respond to Contractor within forty-five (45) days of receipt of the notice by either (i) paying the amount claimed by Contractor or (ii) providing a detailed explanation for the denial of the refund. If the Contractor still disputes the findings of Covered California, Contractor may pursue additional remedies in accordance with Section 12.1. (e) Subject to the provisions of Section 10.5, Contractor agrees to a periodic audit or other examination by Covered California or its designee regarding the computation and payment of Participation Fees. In the case of material non-compliance with Participation Fee payments, Contractor shall implement any necessary corrective action and follow up audits or examinations may be performed by Covered California more frequently than annually to monitor Contractor’s implementation of such corrective actions. (f) Contractor acknowledges that Covered California is required under Government Code § 100520(c) to maintain a prudent reserve as determined by Covered California.

Covered California for Small Business Participation Fees. (a) Contractor understands and agrees that (i) under the Affordable Care Act and the California Affordable Care Act, Covered California may generate funds through a participation fee (“Participation Fees”) on Contractor’s QDPs and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. Covered California shall collect Participation Fee and Agent and General Agent compensation from premiums remitted by Employers and Employees. (b) The Participation Fee payable to Covered California during each month of this Agreement shall be equal to five point two (5.2) percent of the gross premium attributable to each Enrollee in Contractor’s QDPs for such month plus additional fees as necessary to support distribution related expenses. The Participation Fee will be assessed by Covered California and payable monthly by Contractor based on premium attributable to enrollees in Contractor’s QDPs sold through the Covered California for Small Business for 2017-202220222023. The Participation Fee will be reviewed each year as part of the Covered California’s annual budget process. Should Covered California need to collect or refund any premiums for years 2014 to 2016, the Participation Fee shall be calculated pursuant to the QDP Issuer Agreement that was in place during the applicable plan year or years. (c) With respect to Covered California for Small Business, Contractor acknowledges that (i) Covered California is responsible for collecting premiums from Employers and Employees, and (ii) Covered California will remit applicable Employer and Employee premiums collected by Covered California to Contractor, net of (1) Participation Fees computed in accordance with the Participation Methodology - Covered California for Small Business, and (2) Distribution related expenses determined in accordance with the terms set forts at Sections 2.3.3 and 2.3.6. Covered California for Small Business shall transfer funds to Contractor on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor and shall establish a process to resolve any disagreements on premium amounts due in a timely manner and prior to transfer of funds to Contractor as required under this section. (d) In the event that Contractor disputes the amount of Participation Fees billed or deducted by Covered California, Contractor shall submit a written notice of such dispute to the Covered California within thirty (30) days following receipt of such bill or deduction by Covered California. Contractor’s notice will document the nature of the discrepancies, including reconciliation of any differences identified by Contractor in enrollment or premiums collected. Covered California will respond to Contractor within forty-five (45) days of receipt of the notice by either either (i) paying the amount claimed by Contractor or (ii) providing a detailed explanation for the denial of the refund. If the Contractor still disputes the findings of Covered California, Contractor may pursue additional remedies in accordance with Section 12.1. (e) Subject to the provisions of Section 10.5, Contractor agrees to a periodic audit or other examination by Covered California or its designee regarding the computation and payment of Participation Fees. In the case of material non-non- compliance with Participation Fee payments, Contractor shall implement any necessary corrective action and follow up audits or examinations may be performed by Covered California more frequently than annually to monitor Contractor’s implementation of such corrective actions. (f) Contractor acknowledges that Covered California is required under Government Code § 100520(c) to maintain a prudent reserve as determined by Covered California.

Covered California for Small Business Participation Fees. (a) Contractor understands and agrees that (i) under the Affordable Care Act and the California Affordable Care Act, Covered California may generate funds through a participation fee (“Participation Fees”) on Contractor’s QDPs and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. Covered California shall collect Participation Fee and Agent and General Agent compensation from premiums remitted by Employers and Employees. (b) The Participation Fee payable to Covered California during each month of this Agreement shall be equal to five point two (5.2) percent of the gross premium attributable to each Enrollee in Contractor’s QDPs for such month plus additional fees as necessary to support distribution related expenses. The Participation Fee will be assessed by Covered California and payable monthly by Contractor based on premium attributable to enrollees in Contractor’s QDPs sold through the Covered California for Small Business for 2017-20222021. The Participation Fee will be reviewed each year as part of the Covered California’s annual budget process. Should Covered California need to collect or refund any premiums for years 2014 to 2016, the Participation Fee shall be calculated pursuant to the QDP Issuer Agreement that was in place during the applicable plan year or years. (c) With respect to Covered California for Small Business, Contractor acknowledges that (i) Covered California is responsible for collecting premiums from Employers and Employees, and (ii) Covered California will remit applicable Employer and Employee premiums collected by Covered California to Contractor, net of (1) Participation Fees computed in accordance with the Participation Methodology - Covered California for Small Business, and (2) Distribution related expenses determined in accordance with the terms set forts at Sections 2.3.3 and 2.3.6. Covered California for Small Business shall transfer funds to Contractor on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor and shall establish a process to resolve any disagreements on premium amounts due in a timely manner and prior to transfer of funds to Contractor as required under this section. (d) In the event that Contractor disputes the amount of Participation Fees billed or deducted by Covered California, Contractor shall submit a written notice of such dispute to the Covered California within thirty (30) days following receipt of such bill or deduction by Covered California. Contractor’s notice will document the nature of the discrepancies, including reconciliation of any differences identified by Contractor in enrollment or premiums collected. Covered California will respond to Contractor within forty-five (45) days of receipt of the notice by either (i) paying the amount claimed by Contractor or (ii) providing a detailed explanation for the denial of the refund. If the Contractor still disputes the findings of Covered California, Contractor may pursue additional remedies in accordance with Section 12.1. (e) Subject to the provisions of Section 10.5, Contractor agrees to a periodic audit or other examination by Covered California or its designee regarding the computation and payment of Participation Fees. In the case of material non-compliance with Participation Fee payments, Contractor shall implement any necessary corrective action and follow up audits or examinations may be performed by Covered California more frequently than annually to monitor Contractor’s implementation of such corrective actions. (f) Contractor acknowledges that Covered California is required under Government Code § 100520(c) to maintain a prudent reserve as determined by Covered California.

Covered California for Small Business Participation Fees. (a) Contractor understands and agrees that (i) under the Affordable Care Act and the California Affordable Care Act, Covered California the Exchange may generate funds through a participation fee (“Participation ³Participation Fees”´) on Contractor’s Contractor¶s QDPs and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. Covered California shall collect Participation Fee and Agent and General Agent compensation from premiums remitted by Employers and Employeesthe Exchange. (b) The Participation Fee payable to Covered California the Exchange during each month of this Agreement shall be equal to five point two a per member per month (5.2³PMPM´) rate of $.83 multiplied by the number of Enrollees percent of the gross premium attributable to paid by each Enrollee eEnrollee[SV(2] (TBD) in Contractor’s Contractor¶s QDPs for such month plus additional fees as necessary to pay aAgent commissions. This Participation fee is based on the Exchange¶s estimates of the revenue required to support distribution related expensesthe transition of the Exchange to being self-sufficient beginning in 2015. The Participation Fee will be assessed by Covered California the Exchange and payable monthly by Contractor based on premium attributable to enrollment in Contractor'spremium paid by enrollees in Contractor’s QDPs Contractor¶sQDPs sold through the Covered California for Small Business Exchange for 2017-20222019. The Participation Fee will be reviewed each year as part of the Covered California’s Exchange¶s annual budget process. Should Covered California need to collect or refund any premiums for years 2014 to 2016, the Participation Fee shall be calculated pursuant to the QDP Issuer Agreement that was in place during the applicable plan year or years. (c) With respect to Covered California for Small Business, Contractor acknowledges that (i) Covered California the Exchange is responsible for collecting premiums from Employers and Employees, and (ii) Covered California the Exchange will remit applicable Employer and Employee premiums collected by Covered California the Exchange to Contractor, net of (1) Participation Fees computed in accordance with the Participation Methodology - Covered California for Small Business, and (2) Distribution related expenses aAgent commissions determined in accordance with the terms set forts forth at Sections 2.3.3 and 2.3.6. Covered California for Small Business shall transfer funds to Contractor on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor and shall establish a process to resolve any disagreements on premium amounts due in a timely manner and prior to transfer of funds to Contractor as required under this sectionSection 2.3. (d) In the event that Contractor disputes the amount of Participation Fees billed or deducted by Covered California, Contractor shall submit a written notice of such dispute to the Covered California within thirty (30) days following receipt of such bill or deduction by Covered California. Contractor’s notice will document the nature of the discrepancies, including reconciliation of any differences identified by Contractor in enrollment or premiums collected. Covered California will respond to Contractor within forty-five (45) days of receipt of the notice by either (i) paying the amount claimed by Contractor or (ii) providing a detailed explanation for the denial of the refund. If the Contractor still disputes the findings of Covered California, Contractor may pursue additional remedies in accordance with Section 12.1. (e) Subject to the provisions of Section 10.5, Contractor agrees to a periodic audit or other examination by Covered California or its designee regarding the computation and payment of Participation Fees. In the case of material non-compliance with Participation Fee payments, Contractor shall implement any necessary corrective action and follow up audits or examinations may be performed by Covered California more frequently than annually to monitor Contractor’s implementation of such corrective actions. (f) Contractor acknowledges that Covered California is required under Government Code § 100520(c) to maintain a prudent reserve as determined by Covered California.

Covered California for Small Business Participation Fees. (a) Contractor understands and agrees that (i) under the Affordable Care Act and the California Affordable Care Act, Covered California may generate funds through a participation fee (“Participation Fees”) on Contractor’s QDPs and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. Covered California shall collect Participation Fee and Agent and General Agent compensation from premiums remitted by Employers and Employees. (b) The Participation Fee payable to Covered California during each month of this Agreement shall be equal to five point two (5.2) percent of the gross premium attributable to each Covered California Enrollee in Contractor’s QDPs for such month plus additional fees as necessary to support distribution related expenses. The Participation Fee will be assessed by Covered California and payable monthly by Contractor based on premium attributable to enrollees Covered California Enrollees in Contractor’s QDPs sold through the Covered California for Small Business for 2017-20222023. The Participation Fee will be reviewed each year as part of the Covered California’s annual budget process. Should Covered California need to collect or refund any premiums for years 2014 to 2016, the Participation Fee shall be calculated pursuant to the QDP Issuer Agreement that was in place during the applicable plan year or years. (c) With respect to Covered California for Small Business, Contractor acknowledges that (i) Covered California is responsible for collecting premiums from Employers and Employees, and (ii) Covered California will remit applicable Employer and Employee premiums collected by Covered California to Contractor, net of (1) Participation Fees computed in accordance with the Participation Methodology - Covered California for Small Business, and (2) Distribution related expenses determined in accordance with the terms set forts at Sections 2.3.3 and 2.3.6. Covered California for Small Business shall transfer funds to Contractor on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor and shall establish a process to resolve any disagreements on premium amounts due in a timely manner and prior to transfer of funds to Contractor as required under this section. (d) In the event that Contractor disputes the amount of Participation Fees billed or deducted by Covered California, Contractor shall submit a written notice of such dispute to the Covered California within thirty (30) days Days following receipt of such bill or deduction by Covered California. Contractor’s notice will document the nature of the discrepancies, including reconciliation of any differences identified by Contractor in enrollment or premiums collected. Covered California will respond to Contractor within forty-five (45) days Days of receipt of the notice by either either (i) paying the amount claimed by Contractor or (ii) providing a detailed explanation for the denial of the refund. If the Contractor still disputes the findings of Covered California, Contractor may pursue additional remedies in accordance with Section 12.1. (e) Subject to the provisions of Section 10.5, Contractor agrees to a periodic audit or other examination by Covered California or its designee regarding the computation and payment of Participation Fees. In the case of material non-non- compliance with Participation Fee payments, Contractor shall implement any necessary corrective action and follow up audits or examinations may be performed by Covered California more frequently than annually to monitor Contractor’s implementation of such corrective actions. (f) Contractor acknowledges that Covered California is required under Government Code § 100520(c) to maintain a prudent reserve as determined by Covered California.

Covered California for Small Business Participation Fees. (a) Contractor understands and agrees that (i) under the Affordable Care Act and the California Affordable Care Act, Covered California the Exchange may generate funds through a participation fee (“Participation Fees”) on Contractor’s QDPs and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered Californiathe Exchange. Covered California The Exchange shall collect Participation Fee and Agent and General Agent compensation from premiums remitted by Employers and Employees. (b) The Participation Fee payable to Covered California the Exchange during each month of this Agreement shall be equal to five point two (5.2) percent of the gross premium attributable to each Enrollee in Contractor’s QDPs for such month plus additional fees as necessary to support distribution related expenses. The Participation Fee will be assessed by Covered California the Exchange and payable monthly by Contractor based on premium attributable to enrollees in Contractor’s QDPs sold through the Covered California for Small Business Exchange for 2017-20222019. The Participation Fee will be reviewed each year as part of the Covered CaliforniaExchange’s annual budget process. Should Covered California the Exchange need to collect or refund any premiums for years 2014 to 2016, the Participation Fee shall be calculated pursuant to the QDP Issuer Agreement that was in place during the applicable plan year or years. (c) With respect to Covered California for Small Business, Contractor acknowledges that (i) Covered California the Exchange is responsible for collecting premiums from Employers and Employees, and (ii) Covered California the Exchange will remit applicable Employer and Employee premiums collected by Covered California the Exchange to Contractor, net of (1) Participation Fees computed in accordance with the Participation Methodology - Covered California for Small Business, and (2) Distribution related expenses determined in accordance with the terms set forts at Sections 2.3.3 and 2.3.6. Covered California for Small Business shall transfer funds to Contractor on a monthly basis or such other intervals as mutually agreed upon by Covered California the Exchange and Contractor and shall establish a process to resolve any disagreements on premium amounts due in a timely manner and prior to transfer of funds to Contractor as required under this section. (d) In the event that Contractor disputes the amount of Participation Fees billed or deducted by Covered Californiathe Exchange, Contractor shall submit a written notice of such dispute to the Covered California Exchange within thirty (30) days following receipt of such bill or deduction by Covered California. Contractor’s notice will document the nature of the discrepancies, including reconciliation of any differences identified by Contractor in enrollment or premiums collected. Covered California will respond to Contractor within forty-five (45) days of receipt of the notice by either (i) paying the amount claimed by Contractor or (ii) providing a detailed explanation for the denial of the refund. If the Contractor still disputes the findings of Covered California, Contractor may pursue additional remedies in accordance with Section 12.1. (e) Subject to the provisions of Section 10.5, Contractor agrees to a periodic audit or other examination by Covered California or its designee regarding the computation and payment of Participation Fees. In the case of material non-compliance with Participation Fee payments, Contractor shall implement any necessary corrective action and follow up audits or examinations may be performed by Covered California more frequently than annually to monitor Contractor’s implementation of such corrective actions. (f) Contractor acknowledges that Covered California is required under Government Code § 100520(c) to maintain a prudent reserve as determined by Covered California.thirty