Common use of Examination and Audit Results Clause in Contracts

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the results of final financial, market conduct, or special audits/reviews performed by State and Federal Regulators that have jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California for audits/reviews, either by Covered California or its designee, or the Department of General Services, California State Auditors, other state and/or federal regulatory agencies or their designee. Audits/reviews include, the evaluation of the correctness of premium rate setting, Covered California’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contract. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered California, the Department of General Services, the California State Auditors, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement corrective actions of audit/review findings within ninety (90) days. In the instance Contractor cannot implement the corrective action of a finding within ninety (90) days, it will submit a status report to Covered California stating why it cannot correct the finding within the specified time frame and shall propose another date for correction which shall also include a mitigation strategy. In all instances, Contractor and Covered California will do their best to resolve an audit/review finding within one hundred sixty (160) days. Should Contractor disagree with Covered California’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Executive Director whose decision is final and binding on the parties, in term of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the results of final financial, market conduct, or special audits/reviews performed by State and Federal Regulators that have jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California for audits/reviews, either by Covered California or its designee, or the Department of General Services, California State Auditors, other state and/or and federal regulatory agencies or their designee. Audits/reviews include, include the evaluation of the correctness of premium rate setting, Covered California’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee premium payments and Advance Premium Tax Credit advance premium tax credit payments and State premium assistance payments, participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contract. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered California, the Department of General Services, the California State Auditors, other state and federal regulatory agencies agencies, or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement corrective actions of an audit/review findings within ninety (90) days. In the instance Contractor cannot implement the corrective action of a finding within ninety (90) days, it will submit a status report to Covered California stating why it cannot correct the finding within the specified time frame and shall propose another date for correction which shall also include a mitigation strategy. In all instances, Contractor and Covered California will do their best to resolve an audit/review finding within one hundred sixty (160) days. Should Contractor disagree with Covered California’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Executive Director whose decision is final and binding on the parties, in term of administrative due process.ninety

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the results of final financial, market conduct, or special audits/reviews performed by State and Federal Regulators that have jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California for audits/reviews, either by Covered California or its designee, or the Department of General Services, the California State Auditors, other state and/or and federal regulatory agencies or their designee. Audits/reviews include, include the evaluation of the correctness of premium rate setting, Covered California’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contract. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered California, the Department of General Services, the California State Auditors, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation during normal business hours and to allow interviews of any employees Employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement corrective actions of an audit/review findings within ninety (90) days. In the instance Contractor cannot implement the corrective action of a finding within ninety (90) days, it will submit a status report to Covered California stating why it cannot correct the finding within the specified time frame and shall propose another date for correction which shall also include a mitigation strategy. In all instances, Contractor and Covered California will do their best to resolve an audit/review finding within one hundred sixty (160) days. Should Contractor disagree with Covered California’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Executive Director whose decision is final and binding on the parties, in term of administrative due process.ninety

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the results of final financial, market conduct, or special audits/reviews performed by State and Federal Regulators that have jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California for audits/reviews, either by Covered California or its designee, or the Department of General Services, the California State Auditors, other state and/or and federal regulatory agencies or their designee. Audits/reviews include, include the evaluation of the correctness of premium rate setting, Covered California’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contract. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered California, the Department of General Services, the California State Auditors, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation during normal business hours and to allow interviews of any employees Employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement corrective actions of an audit/review findings within ninety (90) days. In the instance Contractor cannot implement the corrective action of a finding within ninety (90) days, it will shall submit a status report to Covered California stating why it cannot correct the finding within the specified time frame and shall propose another date for correction which shall also include a mitigation strategy. In all instances, Contractor and Covered California will do their best to resolve an audit/review finding within one hundred sixty (160) days. Should Contractor disagree with Covered California’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Executive Director whose decision is final and binding on the parties, in term terms of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Social Services, Department of Covered Services, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrolleesenrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deems necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents agents based on the Contractor’s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of an audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instancesinstance, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Health Care Services, California Department of Insurance, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deem necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee premium payments and Advance Premium Tax Credit advance premium tax credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of an audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will shall submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose another date for correction which shall also include a mitigation strategycorrection. In all instances, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term terms of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Social Services, Department of Health Care Services, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrolleesenrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deems necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents agents based on the Contractor’s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of an audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instancesinstance, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Health Care Services, California Department of Insurance, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrolleesenrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deems necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents agentAgents based on the Contractor’s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees eEmployees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of an audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instancesinstance, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term of administrative due process.

Examination and Audit Results. Contractor shall notify the Exchange, and make available, upon request, to the Exchange the results of final financial, market conduct, or special audits performed by the DMHC, CDI, DHCS, DHHS, and/or any other regulatory entity in a State or jurisdiction where Contractor serves Enrollees. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Social Services, Department of Health Care Services, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrolleesenrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deems necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents agents based on the Contractor’s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrolleesaudits. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, shall have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of an audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instancesinstance, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term of administrative due process.. Formatted: Heading 3

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by State and Federal Regulators that have jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deem necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee premium payments and Advance Premium Tax Credit advance premium tax credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of an audit/review findings within ninety (90) days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) days, it will shall submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose another date for correction which shall also include a mitigation strategycorrection. In all instances, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term terms of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Social Services, Department of Health Care Services, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrolleesenrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deems necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents agents based on the Contractor’s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instancesinstance, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Health Care Services, California Department of Insurance, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deem necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee premium payments and Advance Premium Tax Credit advance premium tax credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of an audit/review findings within ninety (90) days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) days, it will shall submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose another date for correction which shall also include a mitigation strategycorrection. In all instances, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term terms of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Social Services, Department of Health Care Services, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deem necessary including determining the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of audit/review findings within ninety (90) days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) days, it will submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instancesinstance, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term of administrative due process.

Examination and Audit Results. (‌ a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Health Care Services, California Department of Insurance, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves EnrolleeseEnrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deems necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents agentAgents based on the Contractor’s report, questions pertaining to Enrollee eEnrollee premium payments and Advance Premium Tax Credit Aadvance Ppremium Ttax Ccredit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of an audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will willshall submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instances, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term terms of administrative due process.

Examination and Audit Results. (‌ a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by State and Federal Regulators that have jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deem necessary including determining the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee premium payments and Advance Premium Tax Credit advance premium tax credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees Employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement.Agreement.‌ (d) Contractor agrees to implement take corrective actions of an audit/review findings within ninety (90) days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) days, it will shall submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose another date for correction which shall also include a mitigation strategycorrection. In all instances, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term terms of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Health Care Services, California Department of Insurance, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deem necessary including determining the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee premium payments and Advance Premium Tax Credit advance premium tax credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees Employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of an audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will shall submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose another date for correction which shall also include a mitigation strategycorrection. In all instances, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term terms of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Social Services, Department of Health Care Services, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deem necessary to determine the correctness of premium rate setting, Covered California’s the Exchange¶s payments to Agents aAgents based on the Contractor’s Contractor¶s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instancesinstance, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered California’s the Exchange¶s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Social Services, Department of Health Care Services, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deem necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instancesinstance, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Social Services, Department of Health Care Services, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deem necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents agents based on the Contractor’s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instancesinstance, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Social Services, Department of Health Care Services, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrolleesenrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deem necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents agents based on the Contractor’s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instancesinstance, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Social Services, Department of Health Care Services, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deem necessary including determining the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instancesinstance, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Health Care Services, California Department of Insurance, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrolleesenrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deem necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit advance premium tax credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees Employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of an audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will shall submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose another date for correction which shall also include a mitigation strategycorrection. In all instances, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term terms of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the results of final financial, market conduct, or special audits/reviews performed by State and Federal Regulators that have jurisdiction where Contractor serves Covered California Enrollees. (b) Contractor agrees to subject itself to Covered California for audits/reviews, either by Covered California or its designee, or the Department of General Services, California State Auditors, other state and/or and federal regulatory agencies or their designee. Audits/reviews include, include the evaluation of the correctness of premium rate setting, Covered California’s payments to Agents based on the Contractor’s report, questions pertaining to Covered California Enrollee premium payments and Advance Premium Tax Credit advance premium tax credit payments and State premium assistance payments, participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contract. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Covered California Enrollees. (c) Contractor agrees that Covered California, the Department of General Services, the California State Auditors, other state and federal regulatory agencies agencies, or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement corrective actions of an audit/review findings within ninety (90) daysDays. In the instance Contractor cannot implement the corrective action of a finding within ninety (90) daysDays, it will shall submit a status report to Covered California stating why it cannot correct the finding within the specified time frame and shall propose another date for correction which shall also include a mitigation strategy. In all instances, Contractor and Covered California will do their best to resolve an audit/review finding within one hundred sixty (160) daysDays. Should Contractor disagree with Covered California’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Executive Director whose decision is final and binding on the parties, in term terms of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by State and Federal Regulators that have jurisdiction where Contractor serves Enrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deem necessary including determining the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of audit/review findings within ninety (90) days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) days, it will submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instancesinstance, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the Exchange the results of final financial, market conduct, or special audits/reviews performed by the Department of Managed Health Care, California Department of Health Care Services, California Department of Insurance, US Department of Health and Human Services, and/or any other regulatory entity within the State and Federal Regulators of California that have has jurisdiction where Contractor serves Enrolleesenrollees. (b) Contractor agrees to subject itself to Covered California the Exchange for audits/reviews, either by Covered California the Exchange or its designee, or the Department of General Services, California the Bureau of State Auditors, other state and/or federal regulatory agencies Audits or their designee. Audits/reviews include, the evaluation of as they deems necessary to determine the correctness of premium rate setting, Covered Californiathe Exchange’s payments to Agents based on the Contractor’s report, questions pertaining to Enrollee enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contractExchange. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Enrollees. (c) Contractor agrees that Covered Californiathe Exchange, the Department of General Services, the California Bureau of State AuditorsAudits, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation records during normal business hours and to allow interviews of any employees Employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement take corrective actions of an audit/review findings within ninety (90) 90 days. In the instance Contractor cannot implement complete the corrective action of a finding within ninety (90) 90 days, it will submit a status report to Covered California the Exchange stating why it cannot correct the finding within the specified time frame and shall propose proposes another date for correction which shall also include a mitigation strategycorrection. In all instancesinstance, Contractor and Covered California the Exchange will do their best to resolve an audit/review finding within one hundred sixty (160) 160 days. Should Contractor disagree with Covered Californiathe Exchange’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Exchange Executive Director whose decision is final and binding on the parties, in term of administrative due process.

Examination and Audit Results. (a) Contractor shall immediately submit to Covered California the results of final financial, market conduct, or special audits/reviews performed by State and Federal Regulators that have jurisdiction where Contractor serves Covered California Enrollees. (b) Contractor agrees to subject itself to Covered California for audits/reviews, either by Covered California or its designee, or the Department of General Services, California State Auditors, other state and/or federal regulatory agencies or their designee. Audits/reviews include, the evaluation of the correctness of premium rate setting, Covered California’s payments to Agents based on the Contractor’s report, questions pertaining to Covered California Enrollee premium payments and Advance Premium Tax Credit payments and participation fee payments which Contractor made to Covered California, Contractor’s compliance with the provision set forth in this contract, and review of the Contractor’s internal controls to perform the duties specified in this contract. Contractor also agrees to all audits subject to applicable State and Federal law regarding the confidentiality of and release of confidential Protected Health Information of Covered California Enrollees. (c) Contractor agrees that Covered California, the Department of General Services, the California State Auditors, other state and federal regulatory agencies or their designated representative, shall, subject to applicable State and Federal law regarding the confidentiality and release of confidential Protected Health Information of Enrollees, have the right to access, review and to copy any information and records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records, information and supporting documentation during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (d) Contractor agrees to implement corrective actions of audit/review findings within ninety (90) daysDays. In the instance Contractor cannot implement the corrective action of a finding within ninety (90) daysDays, it will submit a status report to Covered California stating why it cannot correct the finding within the specified time frame and shall propose another date for correction which shall also include a mitigation strategy. In all instances, Contractor and Covered California will do their best to resolve an audit/review finding within one hundred sixty (160) daysDays. Should Contractor disagree with Covered California’s management decision on an audit/review finding, it may appeal such management decision to the Covered California Executive Director whose decision is final and binding on the parties, in term of administrative due process.