Health Insurers’ Premium Fee under the ACA Sample Clauses

Health Insurers’ Premium Fee under the ACA. The Health Insurerspremium Fee (HIF) under the ACA is due in September each year based on the preceding calendar year premiums each year unless otherwise modified. If the Contractor is or will be subject to the health insurer’s premium fee for the Capitation Payments being made under this or a previously existing Managed Care Contract with the Commonwealth, the Commonwealth shall compensate the Contractor for that fee and for any federal taxes resulting from such compensation. To facilitate this payment, the Contractor shall provide the Department with the Insurer’s Premium Fee assessment received from the Federal Government and the pro rata portion attributed to the Contractor’s Capitation Payments under its Contract(s) for the preceding calendar year if available. In addition, the Contractor shall provide a certified statement from its Chief Financial Officer as to the effective Federal Tax Rate paid for the prior five (5) tax periods. These shall be submitted to the Department no later than September 1 of each year that the Insurer’s premium fee is imposed. This payment method is contingent upon receipt of federal financial participation for the payment and CMS approval.
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Related to Health Insurers’ Premium Fee under the ACA

  • 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.

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

  • 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

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

  • 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.

  • Compliance With Insurance Requirements Borrower will comply with all Insurance requirements and will not permit any condition to exist on the Mortgaged Property that would invalidate any part of any Insurance coverage required under this Loan Agreement.

  • Family and Medical Leave Act (FMLA In accordance with the Family and Medical Leave Act (FMLA) of 1993, the Board will grant a leave of absence for one or more of the following: 1. Because of the birth of a son or daughter of the employee, and in order to care for such son or daughter; 2. Because of the placement of a son or daughter with the employee for adoption or xxxxxx care; 3. To care for the employee's spouse, son or daughter, or par- ent, in laws or members of blended families or other per- sons in a similar relationship that live in the family house- hold or are in a similar family relationship who has a serious health condition; or, 4. The employee is unable to perform the essential job func- tions because of a serious health condition. As of February 2008, an employee who is the spouse, son, daughter, parent or the next of kin of a covered service mem- ber can take up to 26 weeks of FMLA leave during a single twelve (12) month period to care for the injured service mem- ber. The same eligibility requirements apply for employees requesting a leave under this category. Regulations as estab- lished by the Department of Labor will be followed when granting leaves under this provision. FMLA leaves are only available to employees who have been employed by the District for at least twelve (12) months and have worked 1,250 hours during the previous twelve (12) month period. Such leaves are counted against an employee's annual FMLA leave entitlement. Under the FMLA, an employee is eligible for a total of twelve (12) work weeks of leave in a twelve (12) month period. This twelve (12) month period is measured back from the date a requested leave is to begin. Continuation of medical, optical and dental benefits and the right to job restoration ceases when an employee has used twelve (12) work weeks of FMLA leave in the twelve (12) month period. (See Section B, Medical Leave of Absence). An employee requesting a FMLA leave must provide the Xxxxx- xxxx Superintendent of Human Resources at least thirty (30) days advance notice of when the leave is to begin. If such no- xxxx is not practicable, then notice is to be provided as soon as practicable. When a leave denoted as (1) or (2) above is granted, the leave must be taken in one (1) continuous increment, and must be concluded within twelve (12) months of the date of birth or placement. Employees granted such leave must utilize accu- mulated vacation days and accumulated personal business days (in that order), after which time the leave is unpaid. When a leave denoted as (3) above is granted, the employee must utilize accumulated sick leave time, accumulated vacation days, and accumulated personal business days (in that order), after which time the leave is unpaid. When a leave denoted as (4) above is granted, the employee must utilize accumulated sick leave days and accumulated per- xxxxx business days (in that order), after which time the leave is unpaid. After these days have been used and if more sick time is needed, the employee may choose to use accumulated vacation time. When additional time is needed during the 90 calendar day (13 week) LTD elimination period, the employee may use available vacation days. If the employee has pur- chased and is filing for short term disability, vacation days may be used during the 14 day elimination period. Vacation days cannot be used once the short term disability coverage starts. Leaves denoted as (3) or (4) above must be supported by med- ical certification from a health care provider stating (1) the date on which the serious health condition commenced, (2) the probable duration of the condition, (3) the appropriate medical facts, and (4) a statement that the employee is unable to per- form the essential functions of his/her position, or that the em- ployee is needed to care for the person. The District reserves the right to require the employee to obtain the opinion of a sec- ond health care provider designated or approved by the District concerning any information within the medical certification. When a FMLA leave denoted as (1) or (2) above is granted to spouses who are both employed by the District, the total amount of time on leave (in total for both employees) cannot exceed twelve (12) weeks of FMLA time. At the expiration of a medical leave or if the employee wishes to return to work before completion of the leave, there must be a physician's certification confirming his/her fitness to return to work. The District may condition the employee's return to work upon a fitness for duty examination and approval by a health care provider designated by the District. The District will continue to provide an employee's medical, optical and dental insurance while he/she is on a FMLA leave for a period of up to twelve (12) weeks on the same terms and conditions as prior to the leave. An employee on a FMLA leave shall not engage in any outside or supplemental employment. The District may recover insurance premiums paid while an employee was on an unpaid FMLA leave if: 1. The employee fails to return to work for at least thirty (30) days after the expiration of the leave; and 2. The failure to return is for a reason other than a serious health condition, or other circumstances beyond the control of the employee. Certification from the health care provider may be required for this purpose. An employee returning from a FMLA leave will be restored to the position he/she left, or to an equivalent position with equiv- alent benefits, pay and other terms and conditions of employ- ment. If the employee has not satisfactorily completed the probation- ary period at the commencement of a FMLA leave, then upon cessation of the leave, the employee must work the days need- ed to complete the probationary period.

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