Common use of Covered California for Small Business Terminations of Coverage Clause in Contracts

Covered California for Small Business Terminations of Coverage. Contractor acknowledges and agrees that Covered California shall be responsible for the aggregation and administration of premiums for Covered California for Small Business. Covered California shall be responsible for: (1) the submission of bills to each Employer on a monthly basis in a form that identifies Employer and Employee contributions and the total amount due, (2) collecting the amounts due from each Employer, and (3) making payments to Contractor for Enrollees in Contractor’s QDPs on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor. In no event shall Covered California be liable to Contractor with respect to any interest or other charges relating to premium funds received by Covered California that are not yet disbursed by Covered California to QDP Issuers. The specific terms and conditions relating to terminations, including Contractor’s right to terminate an Employer in connection with the receipt of non-payment or partial payments from Employers, shall be established by Covered California in accordance with applicable laws, rules and regulations. Except as otherwise required under applicable laws, rules or regulations, an Employee’s enrollment through Employer may be terminated in connection with the termination of Employer’s coverage and/or with respect to the events described in Section 2.2.4. With respect to an Employee, his or her eligibility shall cease at such time as he or she is no longer a qualified Employee to whom Employer has offered coverage. Covered California will notify Contractor within five (5) business days of any Employer or Employee termination. Contractor shall request termination of an enrollee for fraud or mis-representation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Data Home, Contractor’s folder, Fraud Referral folder)) and provide Covered California with supporting documentation for each request to terminate. Contractor shall not terminate for fraud or misrepresentation without prior approval from Covered California.

Appears in 6 contracts

Samples: Qualified Dental Plan Issuer Contract, Qualified Dental Plan Issuer Contract, Qualified Dental Plan Issuer Contract

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Covered California for Small Business Terminations of Coverage. Contractor acknowledges and agrees that Covered California shall be responsible for the aggregation and administration of premiums for Covered California for Small Business. Covered California shall be responsible for: (1) the submission of bills to each Employer on a monthly basis in a form that identifies Employer and Employee contributions and the total amount due, (2) collecting the amounts due from each Employer, and (3) making payments to Contractor for Covered California Enrollees in Contractor’s QDPs on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor. In no event shall Covered California be liable to Contractor with respect to any interest or other charges relating to premium funds received by Covered California that are not yet disbursed by Covered California to QDP Issuers. The specific terms and conditions relating to terminations, including Contractor’s right to terminate an Employer in connection with the receipt of non-payment or partial payments from Employers, shall be established by Covered California in accordance with applicable laws, rules and regulations. Except as otherwise required under applicable laws, rules or regulations, an Employee’s enrollment through Employer may be terminated in connection with the termination of Employer’s coverage and/or with respect to the events described in Section 2.2.410 CCR § 6538. With respect to an Employee, his or her eligibility shall cease at such time as he or she is no longer a qualified Employee to whom Employer has offered coverage. Covered California will notify Contractor within five (5) business days of notification of any Employer or Employee termination. Contractor shall request termination of an enrollee a Covered California Enrollee for fraud or mis-representation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Data Home, Contractor’s folder, Fraud Referral folder)) and provide Covered California with supporting documentation for each request to terminate. Contractor shall not terminate for fraud or misrepresentation without prior approval from Covered California.

Appears in 4 contracts

Samples: Covered California Qualified Dental Plan Issuer Contract, Qualified Dental Plan Issuer Contract, Qualified Dental Plan Issuer Contract

Covered California for Small Business Terminations of Coverage. Contractor acknowledges and agrees that Covered California shall be responsible for the aggregation and administration of premiums for Covered California for Small Business. Covered California shall be responsible for: (1) the submission of bills to each Employer on a monthly basis in a form that identifies Employer and Employee contributions and the total amount due, (2) collecting the amounts due from each Employer, and (3) making payments to Contractor for Enrollees in Contractor’s QDPs QHPs on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor. In no event shall Covered California be liable to Contractor with respect to any interest or other charges relating to premium funds received by Covered California that are not yet disbursed by Covered California to QDP QHP Issuers. The specific terms and conditions relating to terminations, including Contractor’s right to terminate an Employer in connection with the receipt of non-payment nonpayment or partial payments from Employers, shall be established by Covered California in accordance with applicable laws, rules and regulations. Except as otherwise required under applicable laws, rules or regulations, an Employee’s enrollment through Employer may be terminated in connection with the termination of Employer’s coverage and/or with respect to the events described in Section 2.2.4above. With respect to an Employee, his or her eligibility shall cease at such time as he or she is no longer a qualified Employee to whom Employer has offered coverage. Covered California will notify Contractor within five (5) business days of any Employer or Employee termination. Contractor shall request termination of an enrollee for fraud or mis-representation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Data Home, Contractor’s folder, Fraud Referral folder)) and provide Covered California with supporting documentation for each which substantiates the Contractor’s request to terminate. Contractor shall not terminate for fraud or misrepresentation without prior approval from Covered California.

Appears in 2 contracts

Samples: Qualified Health Plan Issuer Contract, Qualified Health Plan Issuer Contract

Covered California for Small Business Terminations of Coverage. Contractor acknowledges and agrees that Covered California shall be responsible for the aggregation and administration of premiums for Covered California for Small Business. Covered California shall be responsible for: (1) the submission of bills to each Employer on a monthly basis in a form that identifies Employer and Employee contributions and the total amount due, (2) collecting the amounts due from each Employer, and (3) making payments to Contractor for Covered California Enrollees in Contractor’s QDPs QHPs on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor. In no event shall Covered California be liable to Contractor with respect to any interest or other charges relating to premium funds received by Covered California that are not yet disbursed by Covered California to QDP QHP Issuers. The specific terms and conditions relating to terminations, including Contractor’s right to terminate an Employer in connection with the receipt of non-payment nonpayment or partial payments from Employers, shall be established by Covered California in accordance with applicable laws, rules and regulations. Except as otherwise required under applicable laws, rules or regulations, an Employee’s enrollment through Employer may be terminated in connection with the termination of Employer’s coverage and/or with respect to the events described in Section 2.2.4above. With respect to an Employee, his or her eligibility shall cease at such time as he or she is no longer a qualified Employee to whom Employer has offered coverage. Covered California will notify Contractor within five (5) business days of any Employer or Employee termination. Contractor shall request termination of an enrollee a Covered California Enrollee for fraud or mis-representation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Data HomeHub page, Contractor’s foldersubsite, Data Integrity Files, Fraud Referral, Fraud Referral Rev. folder)) and provide Covered California with supporting documentation for each which substantiates the Contractor’s request to terminate. Contractor shall not terminate for fraud or misrepresentation without prior approval from Covered California.

Appears in 1 contract

Samples: Qualified Health Plan Issuer Contract

Covered California for Small Business Terminations of Coverage. Contractor acknowledges and agrees that Covered California shall be responsible for the aggregation and administration of premiums for Covered California for Small Business. Covered California shall be responsible for: (1) the submission of bills to each Employer on a monthly basis in a form that identifies Employer and Employee contributions and the total amount due, (2) collecting the amounts due from each Employer, and (3) making payments to Contractor for Enrollees in Contractor’s QDPs QHPs on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor. In no event shall Covered California be liable to Contractor with respect to any interest or other charges relating to premium funds received by Covered California that are not yet disbursed by Covered California to QDP QHP Issuers. The specific terms and conditions relating to terminations, including Contractor’s right to terminate an Employer in connection with the receipt of non-payment nonpayment or partial payments from Employers, shall be established by Covered California in accordance with applicable laws, rules and regulations. Except as otherwise required under applicable laws, rules or regulations, an Employee’s enrollment through Employer may be terminated in connection with the termination of Employer’s coverage and/or with respect to the events described in Section 2.2.4above. With respect to an Employee, his or her eligibility shall cease at such time as he or she is no longer a qualified Employee to whom Employer has offered coverage. Covered California will notify Contractor within five (5) business days of any Employer or Employee termination. Contractor shall request termination of an enrollee for fraud or mis-representation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Data Home, Contractor’s folder, Fraud Referral folder)) and provide Covered California with supporting documentation for each which substantiates the Contractor’s request to terminate. Contractor shall not terminate for fraud or misrepresentation without prior approval from Covered California.

Appears in 1 contract

Samples: Qualified Health Plan Issuer Contract

Covered California for Small Business Terminations of Coverage. Contractor acknowledges and agrees that Covered California shall be responsible for the aggregation and administration of premiums for Covered California for Small Business. Covered California shall be responsible for: (1) the submission of bills to each Employer on a monthly basis in a form that identifies Employer and Employee contributions and the total amount due, (2) collecting the amounts due from each Employer, and (3) making payments to Contractor for Enrollees in Contractor’s QDPs on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor. In no event shall Covered California be liable to Contractor with respect to any interest or other charges relating to premium funds received by Covered California that are not yet disbursed by Covered California to QDP Issuers. The specific terms and conditions relating to terminations, including Contractor’s right to terminate an Employer in connection with the receipt of non-payment or partial payments from Employers, shall be established by Covered California in accordance with applicable laws, rules and regulations. Except as otherwise required under applicable laws, rules or regulations, an Employee’s enrollment through Employer may be terminated in connection with the termination of Employer’s coverage and/or with respect to the events described in Section 2.2.4. With respect to an Employee, his or her eligibility shall cease at such time as he or she is no longer a qualified Employee to whom Employer has offered coverage. Covered California will notify Contractor within five (5) business days of any Employer or Employee termination. Contractor shall request termination of an enrollee for fraud or mis-representation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Data Home, Contractor’s folder, Fraud Referral folder)) and provide Covered California with supporting documentation for each request to terminate. Contractor shall not terminate for fraud or misrepresentation without prior approval from Covered California.

Appears in 1 contract

Samples: Qualified Dental Plan Issuer Contract

Covered California for Small Business Terminations of Coverage. Contractor acknowledges and agrees that Covered California shall be responsible for the aggregation and administration of premiums for Covered California for Small Business. Covered California shall be responsible for: (1) the submission of bills to each Employer on a monthly basis in a form that identifies Employer and Employee contributions and the total amount due, (2) collecting the amounts due from each Employer, and (3) making payments to Contractor for Enrollees in Contractor’s QDPs QHPs on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor. In no event shall Covered California be liable to Contractor with respect to any interest or other charges relating to premium funds received by Covered California that are not yet disbursed by Covered California to QDP QHP Issuers. The specific terms and conditions relating to terminations, including Contractor’s right to terminate an Employer in connection with the receipt of non-payment nonpayment or partial payments from Employers, shall be established by Covered California in accordance with applicable laws, rules and regulations. Except as otherwise required under applicable laws, rules or regulations, an Employee’s enrollment through Employer may be terminated in connection with the termination of Employer’s coverage and/or with respect to the events described in Section 2.2.4above. With respect to an Employee, his or her eligibility shall cease at such time as he or she is no longer a qualified Employee to whom Employer has offered coverage. Covered California will notify Contractor within five (5) business days of any Employer or Employee termination. Contractor shall request termination of an enrollee for fraud or mis-representation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Data Home, Contractor’s folder, Fraud Referral folder)) and provide Covered California with supporting documentation for each request to terminate. Contractor shall not terminate for fraud or misrepresentation without prior approval from Covered California.Covered

Appears in 1 contract

Samples: Qualified Health Plan Issuer Contract

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Covered California for Small Business Terminations of Coverage. Contractor acknowledges and agrees that Covered California shall be responsible for the aggregation and administration of premiums for Covered California for Small Business. Covered California shall be responsible for: (11i) the submission of bills to each Employer on a monthly basis in a form that identifies Employer and Employee contributions and the total amount due, (22ii) collecting the amounts due from each Employer, and (33iii) making payments to Contractor for Covered California Enrollees in Contractor’s QDPs on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor. In no event shall Covered California be liable to Contractor with respect to any interest or other charges relating to premium funds received by Covered California that are not yet disbursed by Covered California to QDP Issuers. The specific terms and conditions relating to terminations, including Contractor’s right to terminate an Employer in connection with the receipt of non-payment or partial payments from Employers, shall be established by Covered California in accordance with applicable laws, rules and regulations. Except as otherwise required under applicable laws, rules or regulations, an Employee’s enrollment through Employer may be terminated in connection with the termination of Employer’s coverage and/or with respect to the events described in Section 2.2.410 CCR § 6538. With respect to an Employee, his or her eligibility shall cease at such time as he or she is no longer a qualified Employee to whom Employer has offered coverage. Covered California will notify Contractor within five (5) business days of notification of any Employer or Employee termination. Contractor shall request termination of an enrollee a Covered California Enrollee for fraud or mis-representation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Data Home, Contractor’s folder, Fraud Referral folder)) and provide Covered California with supporting documentation for each request to terminate. Contractor shall not terminate for fraud or misrepresentation without prior approval from Covered California.

Appears in 1 contract

Samples: Covered California Qualified Dental Plan Issuer Contract

Covered California for Small Business Terminations of Coverage. Contractor acknowledges and agrees that Covered California shall be responsible for the aggregation and administration of premiums for Covered California for Small Business. Covered California shall be responsible for: (1) the submission of bills to each Employer on a monthly basis in a form that identifies Employer and Employee contributions and the total amount due, (2) collecting the amounts due from each Employer, and (3) making payments to Contractor for Covered California Enrollees in Contractor’s QDPs on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor. In no event shall Covered California be liable to Contractor with respect to any interest or other charges relating to premium funds received by Covered California that are not yet disbursed by Covered California to QDP Issuers. The specific terms and conditions relating to terminations, including Contractor’s right to terminate an Employer in connection with the receipt of non-payment or partial payments from Employers, shall be established by Covered California in accordance with applicable laws, rules and regulations. Except as otherwise required under applicable laws, rules or regulations, an Employee’s enrollment through Employer may be terminated in connection with the termination of Employer’s coverage and/or with respect to the events described in Section 2.2.4. With respect to an Employee, his or her eligibility shall cease at such time as he or she is no longer a qualified Employee to whom Employer has offered coverage. Covered California will notify Contractor within five (5) business days of any Employer or Employee termination. Contractor shall request termination of an enrollee a Covered California Enrollee for fraud or mis-mis- representation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Data Home, Contractor’s folder, Fraud Referral folder)) and provide Covered California with supporting documentation for each request to terminate. Contractor shall not terminate for fraud or misrepresentation without prior approval from Covered California.

Appears in 1 contract

Samples: Qualified Dental Plan Issuer Contract

Covered California for Small Business Terminations of Coverage. Contractor acknowledges and agrees that Covered California shall be responsible for the aggregation and administration of premiums for Covered California for Small Business. Covered California shall be responsible for: (1) the submission of bills to each Employer on a monthly basis in a form that identifies Employer and Employee contributions and the total amount due, (2) collecting the amounts due from each Employer, and (3) making payments to Contractor for Covered California Enrollees in Contractor’s QDPs QHPs on a monthly basis or such other intervals as mutually agreed upon by Covered California and Contractor. In no event shall Covered California be liable to Contractor with respect to any interest or other charges relating to premium funds received by Covered California that are not yet disbursed by Covered California to QDP QHP Issuers. The specific terms and conditions relating to terminations, including Contractor’s right to terminate an Employer in connection with the receipt of non-payment nonpayment or partial payments from Employers, shall be established by Covered California in accordance with applicable laws, rules and regulations. Except as otherwise required under applicable laws, rules or regulations, an Employee’s enrollment through Employer may be terminated in connection with the termination of Employer’s coverage and/or with respect to the events described in Section 2.2.4above. With respect to an Employee, his or her eligibility shall cease at such time as he or she is no longer a qualified Employee to whom Employer has offered coverage. Covered California will notify Contractor within five (5) business days of any Employer or Employee termination. Contractor shall request termination of an enrollee a Covered California Enrollee for fraud or mis-representation misrepresentation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Data HomeCarrier Management (External) page, Contractor’s folder, Data Integrity, Fraud Referral folder)) and provide Covered California with supporting documentation for each which substantiates the Contractor’s request to terminate. Contractor shall not terminate for fraud or misrepresentation without prior approval from Covered California.

Appears in 1 contract

Samples: Qualified Health Plan Issuer Contract

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