Common use of Eligibility Administration Clause in Contracts

Eligibility Administration. The Benefits Center on behalf of the County will determine participant eligibility and provide Contractor with eligibility records. Contractor will be entitled to rely on the eligibility information the County provides and will not maintain or independently verify any portion of the Plan eligibility records. The Benefits Center, on behalf of the County, will provide Contractor with changes in enrollment as soon as practical in the month in which a change in eligibility occurs, but generally no later than sixty (60) calendar days after the effective date of change. Changes in eligibility will be effective on the first of the month, whenever possible. Eligibility information will include new Plan Participants and effective dates of coverage, changes in types or levels of coverage for existing Plan Participants and effective dates of termination of coverage. As Plan Administrator, the County will be responsible for billing and compliance with other administrative requirements of the Consolidated Omnibus Budget Reconciliation Act of 1985, P.L. 99-272 ("COBRA"), as amended, and will include qualified beneficiaries eligible to participate under the Plan pursuant to COBRA in the eligibility information provided to Contractor. Contractor shall: 1. Accept and load eligibility information weekly, within 48 hours of receipt from the Benefits Center. Contractor shall accept eligibility electronically in the County’s current ANSI 834 formatted file and future formats as required by Federal laws and regulations. Provide industry standard file discrepancy reports within 48 hours of receipt of the weekly eligibility file and work with the Benefit Center to research and resolve file discrepancies in a timely manner. 2. Contractor shall notify County or its designee, if the eligibility file is not received by the due date identified on the file schedule provided by the County’ Benefit Center. 3. Contractor shall notify County or its designee prior to the eligibility update application, of any material errors or coding problems on the eligibility file that exceeds agreed upon thresholds. 4. Provide urgent verification of coverage and/or eligibility updates within one (1) business day as directed by the Benefits Center when needed to provide access to care in between eligibility file transmissions. 5. Reconcile enrollment and administrative fee of Plan Participants with the Benefits Center records monthly. Correct information to match the County enrollment information and maintain appropriate claims payment history. 6. Develop, print, and mail Plan identification cards within seven (7) working days of eligibility updates.

Eligibility Administration. The Benefits Center Administrator on behalf of the County will determine participant eligibility and provide Contractor with eligibility records. Contractor will be entitled to rely on the eligibility information the County provides and will not maintain or independently verify any portion of the Plan eligibility records. The Benefits CenterAdministrator, on behalf of the County, will provide Contractor with changes in enrollment as soon as practical in the month in which a change in eligibility occurs, but generally no later than sixty (60) calendar days after the effective date of change. Changes in eligibility will be effective on the first of the month, whenever possible. Eligibility information will include new Plan Participants and effective dates of coverage, changes in types or levels of coverage for existing Plan Participants and effective dates of termination of coverage. As Plan Administrator, the County will be responsible for billing and compliance with other administrative requirements of the Consolidated Omnibus Budget Reconciliation Act of 1985, P.L. 99-272 ("“COBRA"”), as amended, and will include qualified beneficiaries eligible to participate under the Plan pursuant to COBRA in the eligibility information provided to Contractor. Contractor shall: 1. Accept and load eligibility information weekly, within 48 hours of receipt from the Benefits CenterAdministrator. Contractor shall accept eligibility electronically in the County’s current ANSI 834 formatted file and future formats as required by Federal laws and regulations. Provide industry standard file discrepancy reports within 48 hours of receipt of the weekly eligibility file and work with the Benefit Center Administrator to research and resolve file discrepancies in a timely manner. 2. Contractor shall notify County or its designee, if the eligibility file is not received by the due date identified on the file schedule provided by the County’ Benefit CenterAdministrator. 3. Contractor shall notify County or its designee prior to the eligibility update application, of any material errors or coding problems on the eligibility file that exceeds agreed upon thresholds. 4. Provide urgent verification of coverage and/or eligibility updates within one (1) business day as directed by the Benefits Center Administrator when needed to provide access to care in between eligibility file transmissions. 5. Reconcile enrollment and administrative fee of Plan Participants with the Benefits Center Administrator records monthly. Correct information to match the County enrollment information and maintain appropriate claims payment history. 6. Contractor shall perform quarterly full-file reconciliations with the Benefits Administrator. 7. County self-bills its current ASO fees. Contractor shall receive rosters of enrollees for billing purposes and address any billing discrepancies with the Benefits Administrator. 8. Only accept eligibility changes based on information received from the County’s Benefits Administrator or Authorized County Benefits team employees for urgent situations. 9. Develop, print, and mail Plan plan identification cards within seven (7) working days of eligibility updates.

Eligibility Administration. The Benefits Center on behalf of the County will determine participant eligibility and provide Contractor with eligibility records. Contractor will be entitled to rely on the eligibility information the County provides and will not maintain or independently verify any portion of the Plan eligibility records. The Benefits Center, on behalf of the County, will provide Contractor with changes in enrollment as soon as practical in the month in which a change in eligibility occurs, but generally no later than sixty (60) calendar days after the effective date of change. Changes in eligibility will be effective on the first of the month, whenever possible. Eligibility information will include new Plan Participants and effective dates of coverage, changes in types or levels of coverage for existing Plan Participants and effective dates of termination of coverage. As Plan Administrator, the County will be responsible for billing and compliance with other administrative requirements of the Consolidated Omnibus Budget Reconciliation Act of 1985, P.L. 99-272 ("COBRA"), as amended, and will include qualified beneficiaries eligible to participate under the Plan pursuant to COBRA in the eligibility information provided to Contractor. Contractor shall: 1. Accept and load eligibility information weekly, within 48 hours of receipt from the Benefits Center. Contractor shall accept eligibility electronically in the County’s current ANSI 834 formatted file and future formats as required by Federal laws and regulations. Provide industry standard file discrepancy reports within 48 hours of receipt of the weekly eligibility file and work with the Benefit Center to research and resolve file discrepancies in a timely manner. 2. Contractor shall notify County or its designee, if the eligibility file is not received by the due date identified on the file schedule provided by the County’ Benefit Center. 3. Contractor shall notify County or its designee prior to the eligibility update application, of any material errors or coding problems on the eligibility file that exceeds agreed upon thresholds. 4. Provide weekly electronic eligibility information to the County’s Prescription Benefits Manager for Participants and dependents in the Sharewell and Wellwise PPO Plans. Contractor shall reconcile Participant counts and review file discrepancy reports from the PBM within 48 hours and resolve discrepancies in a timely manner. 5. Provide urgent verification of coverage and/or eligibility updates within one (1) business day as directed by the Benefits Center when needed to provide access to care in between eligibility file transmissions. Provide necessary information to the PBM within one (1) business day to allow eligibility update of their system, if applicable. 56. Reconcile enrollment and administrative fee of Plan Participants with the Benefits Center records monthly. Correct information to match the County enrollment information and maintain appropriate claims Claims payment history. 67. Develop, print, and mail Plan identification cards within seven (7) working days of eligibility updates.