Common use of Covered California for the Individual Market Clause in Contracts

Covered California for the Individual Market. 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 QHPs, and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. b) Contractor recognizes that the total cost of all Participation Fees for Covered California must be spread across Contractor’s entire book of business in the single risk pool (both inside and outside Covered California) for the Individual Market. c) The Participation Fee payable to Covered California during each month of this Agreement shall be equal to three point twenty-five (3.25) percent of the gross premium attributable to each Covered California Enrollee in Contractor’s QHPs for such month. The Participation Fee will be assessed by Covered California and payable monthly by Contractor based on Covered California’s gross premium records attributable to effectuated Covered California Enrollees in Contractor's QHPs sold through Covered California for the Individual Market for 2023 - 2025. The Participation Fee will be reviewed each year as part of Covered California’s annual budget process. Should Covered California need to record any positive or negative adjustments to enrollment activity for prior years, the Participation Fee shall be calculated pursuant to the Contractor’s Agreement that was in place during the applicable Plan Year or years. d) Participation Fee invoices will be issued by Covered California to Contractor on the 15th of the month. Contractor’s Participation Fee obligation will be determined and billed by evaluating Contractor’s then-current QHP effectuated enrollment and may be subject to adjustment to reflect changes in enrollment that may have occurred in prior months (including additions, terminations and cancellations of enrollment). Covered California may reduce Contractor’s Participation Fee in specified months as a result of such changes in enrollment. In situations where Covered California has previously authorized and agreed to reimburse Contractor in writing for specified activities, such as additional marketing activities, Covered California may also reduce the Participation Fee to offset Contractor’s expenses. Participation Fee payments will be due fifteen (15) Days from the date the invoice is emailed to Contractor. For invoices paid after fifteen (15) Days from the date the invoice is emailed, Contractor may be assessed a 1% per month late fee on the unpaid balance as of that date. Covered California, in its sole discretion, may assess the late fee for any month that Contractor fails to make the payment by the due date. Participation Fee payments will be applied to the oldest outstanding invoice or overall balance, including prior month late fees, whichever is greater. e) 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 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

Covered California for the Individual Market. 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 QHPs, and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. b) Contractor recognizes that the total cost of all Participation Fees for Covered California must be spread across Contractor’s entire book of business in the single risk pool (both inside and outside Covered California) for the Individual Market. c) The Participation Fee payable to Covered California during each month of this Agreement shall be equal to three point twenty-five (3.25) percent of the gross premium attributable to each Covered California Enrollee in Contractor’s QHPs for such month. The Participation Fee will be assessed by Covered California and payable monthly by Contractor based on Covered California’s gross premium records attributable to effectuated Covered California Enrollees in Contractor's QHPs sold through Covered California for the Individual Market for 2023 - 2025. The Participation Fee will be reviewed each year as part of Covered California’s annual budget process. Should Covered California need to record any positive or negative adjustments to enrollment activity for prior years, the Participation Fee shall be calculated pursuant to the Contractor’s Agreement that was in place during the applicable Plan Year or years. d) Participation Fee invoices will be issued by Covered California to Contractor on the 15th of the month. Contractor’s Participation Fee obligation will be determined and billed by evaluating Contractor’s then-current QHP effectuated enrollment and may be subject to adjustment to reflect changes in enrollment that may have occurred in prior months (including additions, terminations and cancellations of enrollment). Covered California may reduce Contractor’s Participation Fee in specified months as a result of such changes in enrollment. In situations where Covered California has previously authorized and agreed to reimburse Contractor in writing for specified activities, such as additional marketing activities, Covered California may also reduce the Participation Fee to offset Contractor’s expenses. Participation Fee payments will be due fifteen (15) 15 Days from the date the invoice is emailed to Contractor. For invoices paid after fifteen (15) 15 Days from the date the invoice is emailed, Contractor may be assessed a 1% per month late fee on the unpaid balance as of that date. Covered California, in its sole discretion, may assess the late fee for any month that Contractor fails to make the payment by the due date. Participation Fee payments will be applied to the oldest outstanding invoice or overall balance, including prior month late fees, whichever is greater. e) 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 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

Covered California for the Individual Market. 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 QHPs, and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. b) Contractor recognizes that the total cost of all Participation Fees for Covered California must be spread across Contractor’s entire book of business in the single risk pool (both inside and outside Covered California) for the Individual Market. c) The Participation Fee payable to Covered California during each month of this Agreement shall be equal to three point twenty-five (3.25) percent of the gross premium attributable to each Covered California Enrollee in Contractor’s QHPs for such month. The Participation Fee will be assessed by Covered California and payable monthly by Contractor based on Covered California’s gross premium records attributable to effectuated Covered California Enrollees in Contractor's QHPs sold through Covered California for the Individual Market for 2023 - 20252017-2022. The Participation Fee will be reviewed each year as part of Covered California’s annual budget process. Should Covered California need to record any positive or negative adjustments to enrollment activity for prior years, the Participation Fee shall be calculated pursuant to the Contractor’s Agreement that was in place during the applicable Plan Year or years. d) Participation Fee invoices will be issued by Covered California to Contractor on the 15th of the month. Contractor’s Participation Fee obligation will be determined and billed by evaluating Contractor’s then-current QHP effectuated enrollment and may be subject to adjustment to reflect changes in enrollment that may have occurred in prior months (including additions, terminations and cancellations of enrollment). Covered California may reduce Contractor’s Participation Fee in specified months as a result of such changes in enrollment. In situations where Covered California has previously authorized and agreed to reimburse Contractor in writing for specified activities, such as additional marketing activities, Covered California may also reduce the Participation Fee to offset Contractor’s expenses. Participation Fee payments will be due fifteen (15) Days 15 days from the date the invoice is emailed to Contractor. For invoices paid after fifteen (15) Days 15 days from the date the invoice is emailed, Contractor may be assessed a 1% per month late fee on the unpaid balance as of that date. Covered California, in its sole discretion, may assess the late fee for any month that Contractor fails to make the payment by the due date. Participation Fee payments will be applied to the oldest outstanding invoice or overall balance, including prior month late fees, whichever is greater. e) 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 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 (i) paying the amount claimed by Contractor oror (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. f) 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. Covered California may perform follow up audits or examinations more frequently than annually to monitor Contractor’s implementation of such corrective actions. g) 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 the Individual Market. 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 QHPs, and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. b) Contractor recognizes that the total cost of all Participation Fees for Covered California must be spread across Contractor’s entire book of business in the single risk pool (both inside and outside Covered California) for the Individual Market. c) The Participation Fee payable to Covered California during each month of this Agreement shall be equal to three point twenty-five (3.25) percent of the gross premium attributable to each Covered California Enrollee in Contractor’s QHPs for such month. The Participation Fee will be assessed by Covered California and payable monthly by Contractor based on Covered California’s gross premium records attributable to effectuated Covered California Enrollees in Contractor's QHPs sold through Covered California for the Individual Market for 2023 - 20252017-2021. The Participation Fee will be reviewed each year as part of Covered California’s annual budget process. Should Covered California need to record any positive or negative adjustments to enrollment activity for prior years, the Participation Fee shall be calculated pursuant to the Contractor’s Agreement that was in place during the applicable Plan Year or years. d) Participation Fee invoices will be issued by Covered California to Contractor on the 15th of the month. Contractor’s Participation Fee obligation will be determined and billed by evaluating Contractor’s then-current QHP effectuated enrollment and may be subject to adjustment to reflect changes in enrollment that may have occurred in prior months (including additions, terminations and cancellations of enrollment). Covered California may reduce Contractor’s Participation Fee in specified months as a result of such changes in enrollment. In situations where Covered California has previously authorized and agreed to reimburse Contractor in writing for specified activities, such as additional marketing activities, Covered California may also reduce the Participation Fee to offset Contractor’s expenses. Participation Fee payments will be due fifteen (15) Days 15 days from the date the invoice is emailed to Contractor. For invoices paid after fifteen (15) Days 15 days from the date the invoice is emailed, Contractor may be assessed a 1% per month late fee on the unpaid balance as of that date. Covered California, in its sole discretion, may assess the late fee for any month that Contractor fails to make the payment by the due date. Participation Fee payments will be applied to the oldest outstanding invoice or overall balance, including prior month late fees, whichever is greater. e) 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 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 (i) paying the amount claimed by Contractor oror (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. f) 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. Covered California may perform follow up audits or examinations more frequently than annually to monitor Contractor’s implementation of such corrective actions. g) 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 the Individual Market. 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 QHPs, and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. b) Contractor recognizes that the total cost of all Participation Fees for Covered California must be spread across Contractor’s entire book of business in the single risk pool (both inside and outside Covered California) for the Individual Market. c) The Participation Fee payable to Covered California during each month of this Agreement shall be equal to three point twenty-five (3.25) percent of the gross premium attributable to each Covered California Enrollee in Contractor’s QHPs for such month. The Participation Fee will be assessed by Covered California and payable monthly by Contractor based on Covered California’s gross premium records attributable to effectuated Covered California Enrollees in Contractor's QHPs sold through Covered California for the Individual Market for 2023 - 20252017-20212022. The Participation Fee will be reviewed each year as part of Covered California’s annual budget process. Should Covered California need to record any positive or negative adjustments to enrollment activity for prior years, the Participation Fee shall be calculated pursuant to the Contractor’s Agreement that was in place during the applicable Plan Year or years. d) Participation Fee invoices will be issued by Covered California to Contractor on the 15th of the month. Contractor’s Participation Fee obligation will be determined and billed by evaluating Contractor’s then-current QHP effectuated enrollment and may be subject to adjustment to reflect changes in enrollment that may have occurred in prior months (including additions, terminations and cancellations of enrollment). Covered California may reduce Contractor’s Participation Fee in specified months as a result of such changes in enrollment. In situations where Covered California has previously authorized and agreed to reimburse Contractor in writing for specified activities, such as additional marketing activities, Covered California may also reduce the Participation Fee to offset Contractor’s expenses. Participation Fee payments will be due fifteen (15) Days 15 days from the date the invoice is emailed to Contractor. For invoices paid after fifteen (15) Days 15 days from the date the invoice is emailed, Contractor may be assessed a 1% per month late fee on the unpaid balance as of that date. Covered California, in its sole discretion, may assess the late fee for any month that Contractor fails to make the payment by the due date. Participation Fee payments will be applied to the oldest outstanding invoice or overall balance, including prior month late fees, whichever is greater. e) 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 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 (i) paying the amount claimed by Contractor oror (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. f) 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. Covered California may perform follow up audits or examinations more frequently than annually to monitor Contractor’s implementation of such corrective actions. g) 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 the Individual Market. 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 QHPs, and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. b) Contractor recognizes that the total cost of all Participation Fees for Covered California must be spread across Contractor’s entire book of business in the single risk pool (both inside and outside Covered California) for the Individual Market. c) The Participation Fee payable to Covered California during each month of this percent Agreement shall be equal to three point twenty-five (3.25) percent of the gross premium attributable to each Covered California Enrollee in of the Contractor’s QHPs for such month. The Participation Fee will be assessed by Covered California and payable monthly by Contractor based on Covered California’s gross premium records attributable to effectuated Covered California Enrollees in Contractor's QHPs sold through Covered California for the Individual Market for 2023 - 2025. The Participation Fee will be reviewed each year as part of Covered California’s annual budget process. Should Covered California need to record any positive or negative adjustments to enrollment activity for prior years, the Participation Fee shall be calculated pursuant to the Contractor’s Agreement that was in place during the applicable Plan Year or years. d) Participation Fee invoices will be issued by Covered California to Contractor on the 15th of the month. Contractor’s Participation Fee obligation will be determined and billed by evaluating Contractor’s then-current QHP effectuated enrollment and may be subject to adjustment to reflect changes in enrollment that may have occurred in prior months (including additions, terminations and cancellations of enrollment). Covered California may reduce Contractor’s Participation Fee in specified months as a result of such changes in enrollment. In situations where Covered California has previously authorized and agreed to reimburse Contractor in writing for specified activities, such as additional marketing activities, Covered California may also reduce the Participation Fee to offset Contractor’s expenses. Participation Fee payments will be due fifteen (15) 15 Days from the date the invoice is emailed to Contractor. For invoices paid after fifteen (15) 15 Days from the date the invoice is emailed, Contractor may be assessed a 1% per month late fee on the unpaid balance as of that date. Covered California, in its sole discretion, may assess the late fee for any month that Contractor fails to make the payment by the due date. Participation Fee payments will be applied to the oldest outstanding invoice or overall balance, including prior month late fees, whichever is greater. e) 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 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

Covered California for the Individual Market. 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 QHPs, and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. b) Contractor recognizes that the total cost of all Participation Fees for Covered California must be spread across Contractor’s entire book of business in the single risk pool (both inside and outside Covered California) for the Individual Market. c) The Participation Fee payable to Covered California during each month of this Agreement shall be equal to three point twenty-five (3.25) percent of the gross premium attributable to each Covered California Enrollee in Contractor’s QHPs for such month. The Participation Fee will be assessed by Covered California and payable monthly by Contractor based on Covered California’s gross premium records attributable to effectuated Covered California Enrollees in Contractor's QHPs sold through Covered California for the Individual Market for 2023 2017-20222023 - 2025. The Participation Fee will be reviewed each year as part of Covered California’s annual budget process. Should Covered California need to record any positive or negative adjustments to enrollment activity for prior years, the Participation Fee shall be calculated pursuant to the Contractor’s Agreement that was in place during the applicable Plan Year or years. d) Participation Fee invoices will be issued by Covered California to Contractor on the 15th of the month. Contractor’s Participation Fee obligation will be determined and billed by evaluating Contractor’s then-current QHP effectuated enrollment and may be subject to adjustment to reflect changes in enrollment that may have occurred in prior months (including additions, terminations and cancellations of enrollment). Covered California may reduce Contractor’s Participation Fee in specified months as a result of such changes in enrollment. In situations where Covered California has previously authorized and agreed to reimburse Contractor in writing for specified activities, such as additional marketing activities, Covered California may also reduce the Participation Fee to offset Contractor’s expenses. Participation Fee payments will be due fifteen (15) Days 15 daysDays from the date the invoice is emailed to Contractor. For invoices paid after fifteen (15) Days 15 daysDays from the date the invoice is emailed, Contractor may be assessed a 1% per month late fee on the unpaid balance as of that date. Covered California, in its sole discretion, may assess the late fee for any month that Contractor fails to make the payment by the due date. Participation Fee payments will be applied to the oldest outstanding invoice or overall balance, including prior month late fees, whichever is greater. e) 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 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 orunpaid