Common use of Financial Consequences of Non-Payment of Premium Clause in Contracts

Financial Consequences of Non-Payment of Premium. (i) Contractor is responsible for enforcement of premium payment rules at its own expense, as outlined in the terms set forth in the Evidence of Coverage regarding the failure by Enrollee to pay the premium in a timely manner as directed by the Enrollee policy agreement and in accordance with applicable laws, rules and regulations. Enforcement by Contractor shall include, but not be limited to, chargebacks, delinquency and termination actions and notices, grace period requirements and partial payment rules. Such enforcement shall be conducted in accordance with requirements set forth in Section 3.26 and consistent with applicable laws, rules and regulations. (ii) In the event Contractor terminates an Enrollee’s coverage in a QHP due to non- payment of premiums, loss of eligibility, fraud or misrepresentation, change in Enrollees selection of QHP, decertification of Contractor’s QHP and/or as otherwise authorized under Section 3.22 above, Contractor must include the Health Insurance Regulator-approved appeals language in its notice of termination of coverage to the Enrollee. (iii) Contractor acknowledges and agrees that applicable laws, rules and regulations, including the Affordable Care Act and implementing regulations specify a grace period for individuals who receive advance payments of the premium tax credit through the Exchange and that the Xxxx-Xxxxx Act and Insurance Code set a grace period for other individuals with respect to delinquent payments. Contractor agrees to abide by the requirements set forth at Section 3.22 and required under applicable laws, rules and regulations with respect to these grace periods.

Financial Consequences of Non-Payment of Premium. (i) Contractor is responsible for enforcement of premium payment rules at its own expense, as outlined in the terms set forth in the Evidence of Coverage regarding the failure by Enrollee to pay the premium in a timely manner as directed by the Enrollee policy agreement and in accordance with applicable laws, rules and regulations. Enforcement by Contractor shall include, but not be limited to, chargebacks, delinquency and termination actions and notices, grace period requirements and partial payment rules. Such enforcement shall be conducted in accordance with requirements set forth in Section 3.26 3.25 and consistent with applicable laws, rules and regulations. (ii) In the event Contractor terminates an Enrollee’s coverage in a QHP due to non- payment of premiums, loss of eligibility, fraud or misrepresentation, change in Enrollees selection of QHP, decertification of Contractor’s QHP and/or as otherwise authorized under Section 3.22 above, Contractor must include the Health Insurance Regulator-approved appeals language in its notice of termination of coverage to the Enrollee. (iii) Contractor acknowledges and agrees that applicable laws, rules and regulations, including the Affordable Care Act and implementing regulations specify a grace period for individuals who receive advance payments of the premium tax credit through the Exchange and that the Xxxx-Xxxxx Act and Insurance Code set a grace period for other individuals with respect to delinquent payments. Contractor agrees to abide by the requirements set forth at Section 3.22 and required under applicable laws, rules and regulations with respect to these grace periods.

Financial Consequences of Non-Payment of Premium. (i) Contractor is responsible for enforcement of premium payment rules at its own expense, as outlined in the terms set forth in the Evidence of Coverage regarding the failure by Enrollee to pay the premium in a timely manner as directed by the Enrollee policy agreement and in accordance with applicable laws, rules and regulations. Enforcement by Contractor shall include, but not be limited to, chargebacks, delinquency and termination actions and notices, grace period requirements and partial payment rules. Such enforcement shall be conducted in accordance with requirements set forth in Section 3.26 and consistent with applicable laws, rules and regulations. (ii) In the event Contractor terminates an Enrollee’s coverage in a QHP due to non- payment of premiums, loss of eligibility, fraud or misrepresentation, change in Enrollees selection of QHP, decertification of Contractor’s QHP and/or as otherwise authorized under Section 3.22 above, Contractor must include the Health Insurance Regulator-approved appeals language in its notice of termination of coverage to the Enrollee.. Covered California – Final Health Plan Contract – May 202117, 2013 26 (iii) Contractor acknowledges and agrees that applicable laws, rules and regulations, including the Affordable Care Act and implementing regulations specify a grace period for individuals who receive advance payments of the premium tax credit through the Exchange and that the Xxxx-Xxxxx Act and Insurance Code set a grace period for other individuals with respect to delinquent payments. Contractor agrees to abide by the requirements set forth at Section 3.22 and required under applicable laws, rules and regulations with respect to these grace periods.

Financial Consequences of Non-Payment of Premium. (i) Contractor is responsible for enforcement of premium payment rules at its own expense, as outlined in the terms set forth in the Evidence of Coverage regarding the failure by Enrollee to pay the premium in a timely manner as directed by the Enrollee policy agreement and in accordance with applicable laws, rules and regulations. Enforcement by Contractor shall include, but not be limited to, chargebacks, delinquency and termination actions and notices, grace period requirements and partial payment rules. Such enforcement shall be conducted in accordance with requirements set forth in Section 3.26 3.25 and consistent with applicable laws, rules and regulations. (ii) In the event Contractor terminates an Enrollee’s coverage in a QHP due to non- payment of premiums, loss of eligibility, fraud or misrepresentation, change in Enrollees selection of QHP, decertification of Contractor’s QHP and/or as otherwise authorized under Section 3.22 above, Contractor must include the Health Insurance Regulator-approved appeals language in its notice of termination of coverage to the Enrollee. (iii) Contractor acknowledges and agrees that applicable laws, rules and regulations, including the Affordable Care Act and implementing regulations specify a grace period for individuals who receive advance payments of the premium tax credit through the Exchange and that the Xxxx-Xxxxx Act and Insurance Code set a grace period for other individuals with respect to delinquent payments. Contractor agrees to abide by the requirements set forth at Section 3.22 and required under applicable laws, rules and regulations with respect to these grace periods.

Financial Consequences of Non-Payment of Premium. (i) Contractor is responsible for enforcement of premium payment rules at its own expense, as outlined in the terms set forth in the Evidence of Coverage regarding the failure by Enrollee to pay the premium in a timely manner as directed by the Enrollee policy agreement and in accordance with applicable laws, rules and regulations. Enforcement by Contractor shall include, but not be limited to, chargebacks, delinquency and termination actions and notices, grace period requirements and partial payment rules. Such enforcement shall be conducted in accordance with requirements set forth in Section 3.26 3.28 and consistent with applicable laws, rules and regulations. (ii) In the event Contractor terminates an Enrollee’s coverage in a QHP due to non- payment of premiums, loss of eligibility, fraud or misrepresentation, change in Enrollees selection of QHP, decertification of Contractor’s QHP and/or as otherwise authorized under Section 3.22 3.24 above, Contractor must include the Health Insurance Regulator-approved appeals language in its notice of termination of coverage to the Enrollee. (iii) Contractor acknowledges and agrees that applicable laws, rules and regulations, including the Affordable Care Act and implementing regulations specify a grace period for individuals who receive advance payments of the premium tax credit through the Exchange and that the Xxxx-Xxxxx Act and Insurance Code set a grace period for other individuals with respect to delinquent payments. Contractor agrees to abide by the requirements set forth at Section 3.22 3.24 and required under applicable laws, rules and regulations with respect to these grace periods.

Financial Consequences of Non-Payment of Premium. (i) Contractor is responsible for enforcement of premium payment rules at its own expense, as outlined in the terms set forth in the Evidence of Coverage regarding the failure by Enrollee to pay the premium in a timely manner as directed by the Enrollee policy agreement and in accordance with applicable laws, rules and regulations. Enforcement by Contractor shall include, but not be limited to, chargebacks, delinquency and termination actions and notices, grace period requirements and partial payment rules. Such enforcement shall be conducted in accordance with requirements set forth in Section 3.26 and consistent with applicable laws, rules and regulations. (ii) In the event Contractor terminates an Enrollee’s coverage in a QHP SADP due to non- payment of premiums, loss of eligibility, fraud or misrepresentation, change in Enrollees selection of QHPSADP, decertification of Contractor’s QHP SADP and/or as otherwise authorized under Section 3.22 above3.22, Contractor must include the Health Insurance Regulator-approved appeals language in its notice of termination of coverage to the Enrollee. (iii) Contractor acknowledges and agrees that applicable laws, rules and regulations, including the Affordable Care Act and implementing regulations specify a grace period for individuals who receive advance payments of the premium tax credit through the Exchange and that the Xxxx-Xxxxx Act and Insurance Code set a grace period for other individuals with respect to delinquent payments. Contractor agrees to abide by the requirements set forth at Section 3.22 and required under applicable laws, rules and regulations with respect to these grace periods.