Common use of Covered California Termination Clause in Contracts

Covered California Termination. Covered California may, by ninety (90) days’ written notice to Contractor, and without prejudice to any other of Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: a) Contractor fails to fulfill an obligation that is material to its status as a Contractor or its performance under the Agreement; b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section 3.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Enrollees; d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, or other subcontractor agreement for the provision of Services under this Agreement who is, or has been: (A) excluded, debarred, or suspended from participating in any federally funded health care program, (B) suspended, or debarred from participation in any state contract or procurement process, or (C) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Services to beneficiaries of any State or Federal health care program; e) Covered California reasonably determines that (i) the welfare of Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, and applicable laws, rules, and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, or regulations.

Appears in 6 contracts

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

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Covered California Termination. Covered California may, by with ninety (90) days’ written notice to Contractor, and without prejudice to any other of Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: (a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QDP Issuer or its performance under the Agreement; (b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section 3.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; (c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Enrollees; (d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, consulting or other subcontractor agreement for the provision of Services under this Agreement who is, or has been: : (Ai) excluded, debarred, or suspended from participating in any federally funded health care program, (Bii) suspended, suspended or debarred from participation in any state contract or procurement process, or (Ciii) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Health Care Services to beneficiaries of any State or Federal health care program; (e) Covered California reasonably determines that (i) the welfare of Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, agencies and applicable laws, rules, rules and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, rules or regulations.

Appears in 6 contracts

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

Covered California Termination. Covered California may, by ninety (90) days’ written notice to Contractor, and without prejudice to any other of the Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QHP Issuer or its performance under the Agreement; b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section 3.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Enrollees; d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, or other subcontractor agreement for the provision of Services under this Agreement who is, or has been: (A) excluded, debarred, or suspended from participating in any federally funded health care program, (B) suspended, or debarred from participation in any state contract or procurement process, or (C) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Services to beneficiaries of any State or Federal health care program; e) Covered California reasonably determines that (i) the welfare of Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, and applicable laws, rules, and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, or regulations.

Appears in 6 contracts

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

Covered California Termination. Covered California may, by ninety (90) daysDays’ written notice to Contractor, and without prejudice to any other of the Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QHP Issuer or its performance under the Agreement; b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section 3.1.1 4.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days Days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Covered California Enrollees; d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, or other subcontractor Subcontractor agreement for the provision of Services under this Agreement who is, or has been: (A) excluded, debarred, or suspended from participating in any federally funded health care program, (B) suspended, or debarred from participation in any state contract or procurement process, or (C) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Services to beneficiaries of any State or Federal health care program; e) Covered California reasonably determines that (i) the welfare of Covered California Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, and applicable laws, rules, and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, or regulations.

Appears in 3 contracts

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

Covered California Termination. Covered California may, by with ninety (90) daysDays’ written notice to Contractor, and without prejudice to any other of Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: (a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QDP Issuer or its performance under the Agreement; (b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section 3.1.1 4.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; (c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days Days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Covered California Enrollees; (d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, consulting or other subcontractor Subcontractor agreement for the provision of Services under this Agreement who is, or has been: (A) excluded, debarred, or suspended from participating in any federally funded health care program, (B) suspended, suspended or debarred from participation in any state contract or procurement process, or (C) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Services to beneficiaries of any State or Federal health care program; (e) Covered California reasonably determines that (i) the welfare of Covered California Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, agencies and applicable laws, rules, rules and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, rules or regulations.

Appears in 3 contracts

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

Covered California Termination. Covered California may, by ninety (90) daysDays’ written notice to Contractor, and without prejudice to any other of the Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QHP Issuer or its performance under the Agreement; b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section 3.1.1 4.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days Days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Covered California Enrollees; d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, or other subcontractor agreement for the provision of Services under this Agreement who is, or has been: (A) excluded, debarred, or suspended from participating in any federally funded health care program, (B) suspended, or debarred from participation in any state contract or procurement process, or (C) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Services to beneficiaries of any State or Federal health care program; e) Covered California reasonably determines that (i) the welfare of Covered California Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, and applicable laws, rules, and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, or regulations.

Appears in 2 contracts

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

Covered California Termination. Covered California may, by ninety (90) daysDays’ written notice to Contractor, and without prejudice to any other of the Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QHP Issuer or its performance under the Agreement; b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section 3.1.1 4.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days Days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Covered California Enrollees; d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, or other subcontractor Subcontractor agreement for the provision of Services under this Agreement who is, or has been: (Ai) excluded, debarred, or suspended from participating in any federally funded health care program, (Bii) suspended, or debarred from participation in any state contract or procurement process, or (Ciii) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Services to beneficiaries of any State or Federal health care program; e) Covered California reasonably determines that (i) the welfare of Covered California Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, and applicable laws, rules, and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, or regulations.

Appears in 2 contracts

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

Covered California Termination. Covered California may, by ninety (90) daysDays’ written notice to Contractor, and without prejudice to any other of the Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QHP Issuer or its performance under the Agreement; b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section 3.1.1 34.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days Days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Covered California Enrollees; d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, or other subcontractor agreement for the provision of Services under this Agreement who is, or has been: (A) excluded, debarred, or suspended from participating in any federally funded health care program, (B) suspended, or debarred from participation in any state contract or procurement process, or (C) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Services to beneficiaries of any State or Federal health care program; e) Covered California reasonably determines that (i) the welfare of Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, and applicable laws, rules, and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, or regulations.the

Appears in 1 contract

Samples: Qualified Health Plan Issuer Contract

Covered California Termination. Covered California may, by with ninety (90) days’ written notice to Contractor, and without prejudice to any other of Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: (a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QDP Issuer or its performance under the Agreement; (b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section Section 3.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; (c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Enrollees; (d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, consulting or other subcontractor agreement for the provision of Services under this Agreement who is, or has been: (Ai) excluded, debarred, or suspended from participating in any federally funded health care program, (Bii) suspended, suspended or debarred from participation in any state contract or procurement process, or (Ciii) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Health Care Services to beneficiaries of any State or Federal health care program; (e) Covered California reasonably determines that (i) the welfare of Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, agencies and applicable laws, rules, rules and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, rules or regulations.

Appears in 1 contract

Samples: Qualified Dental Plan Issuer Contract

Covered California Termination. Covered California may, by with ninety (90) daysDays’ written notice to Contractor, and without prejudice to any other of Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: (a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QDP Issuer or its performance under the Agreement; (b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section Section 3.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; (c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days Days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Covered California Enrollees; (d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, consulting or other subcontractor agreement for the provision of Services under this Agreement who is, or has been: (Ai) excluded, debarred, or suspended from participating in any federally funded health care program, (Bii) suspended, suspended or debarred from participation in any state contract or procurement process, or (Ciii) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Health Care Services to beneficiaries of any State or Federal health care program; (e) Covered California reasonably determines that (i) the welfare of Covered California Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, agencies and applicable laws, rules, rules and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, rules or regulations.

Appears in 1 contract

Samples: Qualified Dental Plan Issuer Contract

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Covered California Termination. Covered California may, by with ninety (90) daysDays’ written notice to Contractor, and without prejudice to any other of Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: (a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QDP Issuer or its performance under the Agreement; (b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section 3.1.1 4.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; (c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days Days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Covered California Enrollees; (d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, consulting or other subcontractor agreement for the provision of Services under this Agreement who is, or has been: (A) excluded, debarred, or suspended from participating in any federally funded health care program, (B) suspended, suspended or debarred from participation in any state contract or procurement process, or (C) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Services to beneficiaries of any State or Federal health care program; (e) Covered California reasonably determines that (i) the welfare of Covered California Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, agencies and applicable laws, rules, rules and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, rules or regulations.

Appears in 1 contract

Samples: Qualified Dental Plan Issuer Contract

Covered California Termination. Covered California may, by with ninety (90) daysDays’ written notice to Contractor, and without prejudice to any other of Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: (a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QDP Issuer or its performance under the Agreement; (b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section 3.1.1 34.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; (c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days Days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Covered California Enrollees; (d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, consulting or other subcontractor agreement for the provision of Services under this Agreement who is, or has been: (AiA) excluded, debarred, or suspended from participating in any federally funded health care program, (BiiB) suspended, suspended or debarred from participation in any state contract or procurement process, or (CiiiC) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Health Care ServicesCovered Services to beneficiaries of any State or Federal health care program; (e) Covered California reasonably determines that (i) the welfare of Covered California Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, agencies and applicable laws, rules, rules and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, rules or regulations.

Appears in 1 contract

Samples: Qualified Dental Plan Issuer Contract

Covered California Termination. Covered California may, by ninety (90) daysDays’ written notice to Contractor, and without prejudice to any other of the Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QHP Issuer or its performance under the Agreement; b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section 3.1.1 4.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days Days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Covered California Enrollees; d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, or other subcontractor Subcontractor agreement for the provision of Services under this Agreement who is, or has been: (A) excluded, debarred, or suspended from participating in any federally funded health care program, (B) suspended, or debarred from participation in any state contract or procurement process, or (C) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Services to beneficiaries of any State or Federal health care program; e) Covered California reasonably determines that (i) the welfare of Covered California Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, and applicable laws, rules, and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, or regulations.

Appears in 1 contract

Samples: Covered California Qualified Health Plan Issuer Contract

Covered California Termination. Covered California may, by ninety (90) daysDays’ written notice to Contractor, and without prejudice to any other of the Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QHP Issuer or its performance under the Agreement; b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section 3.1.1 4.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days Days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Covered California Enrollees; d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, or other subcontractor Subcontractor agreement for the provision of Services under this Agreement who is, or has been: (Ai) excluded, debarred, or suspended from participating in any federally funded health care program, (Bii) suspended, or debarred from participation in any state contract or procurement process, or (Ciii) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Services to beneficiaries of any State or Federal health care program; e) Covered California reasonably determines that (i) the welfare of Covered California Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, and applicable laws, rules, and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, or regulations.

Appears in 1 contract

Samples: Qualified Health Plan Issuer Contract

Covered California Termination. Covered California may, with by ninety (90) daysDays’ written notice to Contractor, and without prejudice to any other of Covered California remedies, terminate this Agreement for cause based on one or more of the following occurrences: (a) Contractor fails to fulfill an obligation that is material to its status as a Contractor QDP Issuer or its performance under the Agreement; (b) Contractor no longer holds a license or certificate that is required for Contractor to perform its obligations under this Agreement /or or Contractor otherwise fails to maintain compliance with the “good standing” requirements pursuant to Section 3.1.1 4.1.1 and which impairs Contractor’s ability to provide Services under the Agreement; (c) Contractor breaches any material term, covenant, warranty, or obligation under this Agreement that is not cured or substantially cured to the reasonable satisfaction of Covered California within forty-five (45) days Days after receipt of notice of default from Covered California; provided, however, that such cure period may not be required and Covered California may terminate the Agreement immediately if Covered California determines pursuant to subparagraph (e) below that Contractor’s breach threatens the health and safety of Covered California Enrollees; (d) Contractor knowingly has a director, officer, partner, or person with a beneficial ownership of more than five percent (5%) of Contractor’s equity or has an employment, consulting, consulting or other subcontractor Subcontractor agreement for the provision of Services under this Agreement who is, or has been: (AAi) excluded, debarred, or suspended from participating in any federally funded health care program, (BBii) suspended, suspended or debarred from participation in any state contract or procurement process, or (CCiii) convicted of a felony or misdemeanor (or entered a plea of nolo contendere) related to a crime or violation involving the acquisition or dispersal of funds or delivery of Covered Services to beneficiaries of any State or Federal health care program; (e) Covered California reasonably determines that (i) the welfare of Covered California Enrollees is in jeopardy if this Agreement continues, as such determination shall be made in the reasonable discretion of Covered California based on consideration of professionally recognized standards and benchmarks, requirements imposed by accreditation agencies, agencies and applicable laws, rules, rules and regulations; or (ii) Contractor fails to comply with a change in laws, rules or regulations occurring during the term of this Agreement and/or does not take any and all actions that may be required to amend the Agreement and otherwise establish and document compliance with any such changes; and (iii) Covered California reasonably determines, based on consultation with legal counsel and/or other State and Federal Regulators and/or other State-based or Federal health benefit exchanges, that it may be at risk of being found noncompliant with Federal or State laws, rules, rules or regulations.

Appears in 1 contract

Samples: Covered California Qualified Dental Plan Issuer Contract

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