Covered California Responsibilities. (a) Covered California shall be solely responsible for the determination of eligibility and enrollment of individuals in Covered California in accordance with applicable Federal and State laws, rules and regulations. (b) Covered California shall determine eligibility and enroll eligible individuals in Covered California pursuant to its management and participation in CalHEERS, a project jointly sponsored by Covered California and DHCS with the assistance of the Office of Systems Integration. Covered California shall also determine eligibility and enroll Qualified Employees and dependents for employer sponsored dental coverage. Covered California and CalHEERS shall develop, implement and maintain processes to make the eligibility and enrollment decisions regarding Covered California and other California health care programs and submit that information to Contractor in a timely manner in accordance with Federal and State laws, rules and regulations and the terms set forth in this Agreement. (c) Covered California shall notify Contractor regarding each eligible applicant who has completed an application for enrollment and designated Contractor as the QDP Issuer. Covered California shall transmit information required for Contractor to enroll the applicant, and Contractor shall enroll applicant within five (5) business days of receipt of verification of eligibility and selection of Contractor’s QDP. (d) Covered California shall send enrollment information to Contractor on a daily basis and Contractor shall reconcile specified enrollment information received from Covered California with Contractor’s enrollment data on a monthly basis through the Reconciliation Process. (e) Covered California shall utilize the Dispute Process pursuant to Section 2.1.2
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Samples: Covered California Qualified Dental Plan Issuer Contract, Covered California Qualified Dental Plan Issuer Contract, Qualified Dental Plan Issuer Contract
Covered California Responsibilities. (a) Covered California shall be solely responsible for the determination of eligibility and enrollment of individuals in Covered California in accordance with applicable Federal and State laws, rules and regulations.
(b) Covered California shall determine eligibility and enroll eligible individuals in Covered California pursuant to its management and participation in CalHEERS, a project jointly sponsored by Covered California and DHCS with the assistance of the Office of Systems Integration. Covered California shall also determine eligibility and enroll Qualified Employees and dependents for employer sponsored dental coverage. Covered California and CalHEERS shall develop, implement and maintain processes to make the eligibility and enrollment decisions regarding Covered California and other California health care programs and submit that information to Contractor in a timely manner in accordance with Federal and State laws, rules and regulations and the terms set forth in this Agreement.
(c) Covered California shall notify Contractor regarding each eligible applicant who has completed an application for enrollment and designated Contractor as the QDP Issuer. Covered California shall transmit information required for Contractor to enroll the applicant, and Contractor shall enroll applicant within five (5) business days of receipt of verification of eligibility and selection of Contractor’s QDP.
(d) Covered California shall send enrollment information to Contractor on a daily basis and Contractor shall reconcile specified enrollment information received from Covered California with Contractor’s enrollment data on a monthly basis through the Reconciliation Process.
(e) Covered California shall utilize the Dispute Process pursuant to Section 2.1.2
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