Health Insurance Providers Fee Sample Clauses

Health Insurance Providers Fee. If the MCO is identified by the Internal Revenue Service as being subject to the annual health insurer fee (“Annual Fee”) required under Section 9010 of the ACA, the STATE will make a payment in order to satisfy the requirement for actuarial soundness set forth in 42 CFR 438.(4) for amounts paid by the STATE under this Contract.
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Health Insurance Providers Fee. Section 9010 of the Patient Protection and Affordable Care Act Pub. L. No. 111-148 (124 Stat. 119 (2010)), as amended by Section 10905 of PPACA, and as further amended by Section 1406 of the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152 (124 Stat. 1029 (2010)) imposes an annual fee on health insurance providers beginning in 2014 (“Annual Fee”). Contractor is responsible for a percentage of the Annual Fee for all health insurance providers as determined by the ratio of Contractor’s net written premiums for the preceding year compared to the total net written premiums of all entities subject to the Annual Fee for the same year. The State shall reimburse the Contractor for the amount of the Annual Fee specifically allocable to the premiums paid during this Contract Term for each calendar year or part thereof, including an adjustment for the full impact of the non-deductibility of the Annual Fee for Federal and state tax purposes, including income and excise taxes (“Contractor’s Adjusted Fee”). The Contractor’s Adjusted Fee shall be determined based on the final notification of the Annual Fee amount Contractor or Contractor’s parent receives from the United States Internal Revenue Service. The State, following its review and acceptance of the Contractor’s Adjusted Fee, will retroactively adjust the Contractor’s capitation rates to provide reimbursement for the Contractor’s Adjusted Fee. To claim reimbursement for the Contractor’s Adjusted Fee the Contractor shall submit a certified copy of its full Annual Fee assessment within sixty (60) days of receipt, together with the allocation of the Annual Fee attributable specifically to its premiums under this Contract. The Contractor shall also submit the calculated adjustment for the impact of non-deductibility of the Annual Fee attributable specifically to its premiums under this Contract, and any other data deemed necessary by the State to validate the reimbursement amount. These materials shall be submitted under the signatures of either its Financial Officer or Executive leadership (e.g., President, Chief Executive Office, Executive Director), certifying the accuracy, truthfulness and completeness of the data provided.
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Health Insurance Providers Fee. If the MCO is identified by the Internal Revenue Service as being subject to the annual health insurer fee (“Annual Fee”) required under Section 9010 of the ACA, the STATE will make a payment in order to satisfy the requirement for actuarial soundness set forth in 42 CFR § 438.4, (c) for amounts paid by the STATE under this Contract.‌ MCO Duties.‌ The MCO shall provide the STATE with a copy of its final Form 8963 and Schedule A at the controlled entity level, as submitted to the IRS, within ten (10) business days of the filing. The MCO shall also provide any corrected Form 8963 filings submitted to the IRS within ten (10) business days of the amended filing. The MCO shall also submit to the STATE: A schedule that reconciles direct premium (Form 8963, Schedule A, item (f)) for the MCO to Line 8 of the Minnesota Supplement Report #1. The dollar amount of revenue for Covered Services that the MCO determined should be excluded from Form 8963, Schedule A, item (f), including but not limited to long-term care, nursing home care, home health care, and community-based care. If applicable, MCO shall provide information needed to calculate the effect of taxes upon the final fee. This may include taxes paid that affect the final total to be reimbursed to the MCO. The MCO shall provide the STATE with the preliminary calculation of the MCO’s Allocated Annual Fee (the amount of its Annual Fee allocable to this Contract at the controlled entity level), as determined by the IRS, within ten (10) business days of receiving this information from the IRS. The MCO shall provide the STATE with the final calculation of the MCO’s Allocated Annual Fee as determined by the IRS, no later than ten (10) business days of receiving this information from the IRS, with a data certification pursuant to section 9.10. Upon request, the MCO shall provide any other documentation required by the STATE to validate the MCO’s Allocated Annual Fee or apportionment among Enrollee populations.
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Health Insurance Providers Fee. Section 9010 of the Patient Protection and Affordable Care Act Pub. L. No. 111-148 (124 Stat. 119 (2010)), as amended by Section 10905 of PPACA, and as further amended by Section 1406 of the Health Care and Education Reconciliation Act of 2010, Pub. L. No 111-152 (124 Stat. 1029 (2010)) imposes an annual fee on health insurance providers (“Annual Fee”). The Contractor is responsible for a percentage of the Annual Fee for all health insurance providers as determined by the ratio of Contractor’s net written premiums for the preceding year compared to the total net written premiums of all entities subject to the Annual Fee for the same year.
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Health Insurance Providers Fee. (a) For purposes of the health insurance providers fee imposed by Section 9010 of the Patient Protection and Affordable Care Act (PPACA), Public Law 111-148 (124 Stat. 119 (2010)), as amended by Section 10905 of PPACA, and as further amended by Section 1406 of the Health Care and Reconciliation Act of 2010, Public Law 111-152 (124 Stat. 1029 (2010) and the Treasury Regulations promulgated with respect thereto, or any successor Law or Tax (such fee, the “Health Insurance Providers Fee”), Seller shall (i) treat all reinsurance arrangements between Buyer (or an Affiliate of Buyer) and Seller pursuant to the Medicare Reinsurance Agreement and the QHP and EP Reinsurance Agreement as “indemnity reinsurance” as defined in Treasury Regulations Section 57.2(h)(5)(i), (ii) report all premiums received by Seller in connection with the Medicare Business and the QHP and EP Reinsurance Business with respect to any Contract for “health insurance” (within the meaning of Treasury Regulations Section 57.2(h)), for any period (or portion thereof) beginning on or after the Closing Date and ending at such time as the Contract has been novated to Buyer, as Seller’s “premiums written” for health insurance of United States health risks (within the meaning of Treasury Regulations Section 57.2) and (iii) determine Seller’s “net premiums written” without reducing such “premiums written” described in clause (i) by any amount ceded to or otherwise payable to Buyer under any indemnity reinsurance arrangement described herein. Seller and Buyer shall report and shall act, in all respects and for all Tax purposes, consistent with such position and neither Seller nor Buyer shall take any position (whether in audits, Tax Returns, or otherwise) that is inconsistent with such position. (b) In the event that Buyer is required to pay a Health Insurance Providers Fee in respect of any of the premiums described in Section 6.19(a) with respect to the Medicare Business and the QHP and EP Reinsurance Business, Seller shall pay to Buyer in accordance with Section 6.19(c) an amount equal to any Health Insurance Providers Fee that would have been payable by Seller in respect of such premiums had the Closing not occurred, determined assuming that (i) Seller is a “covered entity” (within the meaning of Treasury Regulations Section 57.2(b)) in the applicable “test year” (within the meaning of Treasury Regulations Section 57.2(g), (ii) Seller continues to be a New York not-for-profit corporation that is ex...
Sample 1
Health Insurance Providers Fee. Section 9010 of the Patient Protection and Affordable Care Act Pub. L. No. 111-148 (124 Stat. 119 (2010)), as amended by Section 10905 of PPACA, and as further amended by Section 1406 of the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152 (124 Stat. 1029 (2010)) imposes an annual fee on health insurance providers Annual Fee for all health insurance providers as determined by the net written premiums for the preceding year compared to the total net written premiums of all entities subject to the Annual Fee for the same year. The State shall reimburse the Contractor for the amount of the Annual Fee specifically allocable to the premiums paid during this Contract Term for each calendar year or part thereof, including an adjustment for the full impact of the non-deductibility of the Annual Fee for Federal and state tax purposes, including income and excise taxes ( United States Internal Revenue Service. The State, following its review and acceptance mit a certified copy of its full Annual Fee assessment within sixty (60) days of receipt, together with the allocation of the Annual Fee attributable specifically to its premiums under this Contract. The Contractor shall also submit the calculated adjustment for the impact of non-deductibility of the Annual Fee attributable specifically to its premiums under this Contract, and any other data deemed necessary by the State to validate the reimbursement amount. These materials shall be submitted under the signatures of either its Financial Officer or Executive leadership (e.g., President, Chief Executive Office, Executive Director), certifying the accuracy, truthfulness and completeness of the data provided.
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Related to Health Insurance Providers Fee

  • Health Insurance The Couple agrees that: (check one)

  • Health insurance premiums If you are unemployed and have received unemployment compensation for 12 consecutive weeks under a federal or state program, you may take payments from your IRA to pay for health insurance premiums without incurring the 10 percent early distribution penalty tax.

  • Retiree Health Insurance Retired members of the Department receiving, or to receive City of Lincoln monthly pension checks, may participate in the group comprehensive health care plan for active City employees, provided that each retiree so desiring will execute the required forms in a timely fashion, and further provided that each retiree will be required to pay the full monthly cost at the current rates subject to any rate increases which may occur from time to time. Such payment will be made by payroll deduction from pension checks, or by direct payment in the case of an early retiree.

  • Health Insurance Benefits To the extent provided by the federal COBRA law or, if applicable, state insurance laws, and by the Company’s current group health insurance policies, Executive will be eligible to continue Executive’s group health insurance benefits at Executive’s own expense. If Executive timely elects continued coverage under COBRA, the Company shall pay Executive’s COBRA premiums, and any applicable Company COBRA premiums, necessary to continue Executive’s then-current coverage for a period of 12 months after the date of Executive’s termination of employment; provided, however, that any such payments will cease if Executive voluntarily enrolls in a health insurance plan offered by another employer or entity during the period in which the Company is paying such premiums. Executive agrees to immediately notify the Company in writing of any such enrollment. Notwithstanding the foregoing, if the Company determines, in its sole discretion, that it cannot provide the foregoing benefit without potentially incurring financial costs or penalties under applicable law (including, without limitation, Section 2716 of the Public Health Service Act), the Company shall in lieu thereof provide to Executive a taxable monthly amount to continue his group health insurance coverage in effect on the date of separation from service (which amount shall be based on the premium for the first month of COBRA coverage), which payments shall be made regardless of whether Executive elects COBRA continuation coverage and shall commence in the month following the month in which Executive incurs a separation from service and shall end on the earlier of (x) the date on which Executive voluntarily enrolls in a health insurance plan offered by another employer or entity during the period in which the Company is paying such amounts and (y) 12 months after the date of Executive’s separation from service.

  • Group Health Insurance The Employer shall provide a comprehensive health care insurance program for all permanent full-time and part-time employees. Health Plan characteristics and benefits shall be as provided in the Employer’s Agreement with the Ohio Civil Service Employees Association (hereinafter OCSEA). Regardless of the plan, employees will pay fifteen percent (15%) of the premium and the Employer will pay eighty-five percent (85%) of the premium; however for any alternative plans offered pursuant to the Agreement with OCSEA, the employees’ premium share will be determined by the Director of DAS, but will not exceed fifteen percent (15%) of the premium. The Employer’s premium share shall be paid on behalf of eligible employees as provided in the Employer’s Agreement with OCSEA. Employees who include a spouse as a dependent for healthcare coverage shall pay a surcharge as provided in the Employer’s Agreement with OCSEA. Eligibility provisions for employees enrolling in State provided health care plans shall remain the same as those in effect in the Employer’s Agreement with OCSEA. The Employer reserves the right to perform dependent eligibility audits upon recommendation of the Joint Health Care Committee. Health care costs paid on behalf of ineligible dependents will be subject to recovery. Deductibles, co-payments, and other plan design provisions for all benefit programs shall be the same as those prescribed in the Employer’s Agreement with OCSEA. Every year the Employer shall conduct an open enrollment period, at which time employees shall be able to enroll in a health plan, continue enrollment in their current plan, switch to another plan, subject to plan availability in their area, or waive coverage. The timing of the open enrollment period shall be established by the Director of the Department of Administrative Services (DAS), in consultation with the Joint Health Care Committee. Changes outside of open enrollment may only occur as prescribed in the Employer’s Agreement with OCSEA. Open Enrollment Fairs shall be held in accordance with Employer’s Agreement with OCSEA. There shall be established a Joint Health Care Committee composed of representatives of management, and of the various labor Unions representing State employees. The Committee shall meet regularly to monitor the operation of the State’s health care plans, and to make recommendations for the improvement of the plans and cost containment procedures. The Employer shall provide funding for dental, vision and the life benefits as described in Article 21 of the Employer’s Agreement with OCSEA and the Union’s Benefits Trust. Employee health insurance payments will be deducted from every paycheck. In the event an employee is receiving disability leave or Workers’ Compensation benefits, the Employer- policyholder shall continue, at no cost to the employee, the coverage of group health insurance for such employee for the period of such leave, but not beyond twelve (12) months. If the employee’s leave extends beyond twelve

  • Health Insurance Coverage (a) An employee who is laid off or separated from employment on or after July 1, 1994, under circumstances which entitle such employee to reemployment rights under this Article, other than pursuant to Section 23, may elect to continue membership in their health benefit plan, upon advance payment of the regular percentage contribution to the cost of the plan, during the first six

  • Additional Insurance Provisions (A) The foregoing requirements as to the types and limits of insurance coverage to be maintained by Consultant, and any approval of said insurance by the City, is not intended to and shall not in any manner limit or qualify the liabilities and obligations otherwise assumed by the Consultant pursuant to this Agreement, including but not limited to, the provisions concerning indemnification. (B) If at any time during the life of the Agreement, any policy of insurance required under this Agreement does not comply with these specifications or is canceled and not replaced, City has the right but not the duty to obtain the insurance it deems necessary and any premium paid by City will be promptly reimbursed by Consultant or City will withhold amounts sufficient to pay premium from Consultant payments. In the alternative, City may cancel this Agreement. (C) The City may require the Consultant to provide complete copies of all insurance policies in effect for the duration of the Project. (D) Neither the City nor any of its officials, officers, employees, agents or volunteers shall be personally responsible for any liability arising under or by virtue of this Agreement. (E) The limits set forth herein shall apply separately to each insured against whom claims are made or suits are brought, except with respect to the limits of liability. Further the limits set forth herein shall not be construed to relieve the Consultant from liability in excess of such coverage, nor shall it limit the Consultant’s indemnification obligations to the City and shall not preclude the City from taking such other actions available to the City under other provisions of the Agreement or law. (F) Consultant shall report to the City, in addition to Consultant’s insurer, any and all insurance claims submitted by Consultant in connection with the Services under this Agreement.

  • Health Benefits For the eighteen (18) month period following the Termination Date, provided that Executive is eligible for, and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretion.

  • Health Insurance Portability and Accountability Act Grantee certifies that it is in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law Xx. 000-000, 00 XXX Parts 160, 162 and 164, and the Social Security Act, 42 USC 1320d-2 through 1320d-7, in that it may not use or disclose protected health information other than as permitted or required by law and agrees to use appropriate safeguards to prevent use or disclosure of the protected health information. Grantee shall maintain, for a minimum of six (6) years, all protected health information.

  • Health Insurance Portability and Accountability Act of 1996 This paragraph was intentionally left blank.

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