Common use of Licensure of the Contractor Clause in Contracts

Licensure of the Contractor. The Contractor has a valid license to operate as an HMO or Insurer, issued by DOI. There are no outstanding unresolved material Appeals or Grievances filed against Contractor with DOI. The Contractor has timely filed all reports required by DOI and DOI has taken no adverse action against Contractor of which FAC has not been notified. As an HMO or Insurer under Subtitle 3 of the Kentucky Insurance Code with a health line of authority, and regardless of the non-applicability of any other provision of the Kentucky Insurance Code or any legal authority cited herein, pursuant to this Contract the Contractor agrees to be subject to a one percent (1%) annual assessment on Capitation Payments that follow the provisions of any broad based assessment within state law including but not limited to the Governor’s Enacted Budget, KRS 304.17B-021 or KRS 142.316, subject to the approval of CMS. The one percent (1%) assessment is a component of the Capitation Rates as contained in Appendix A “Capitation Payment Rates.” On or about March 1st of each year, the Department shall notify the Contractor in writing that the annual assessment is due and the Contractor shall have thirty (30) calendar days to remit payment in full to the Department. In the event the assessment is increased, the increase shall be provided for in an amended Capitation Rate. If CMS fails to approve this component of the rates, or if the assessment is otherwise deemed non- collectable, the Capitation Payment rates shall be adjusted to remove that component from the Capitation Rate.

Licensure of the Contractor. The Contractor has a valid license to operate as an HMO or Insurerinsurer, issued by the DOI. There are no outstanding unresolved material Appeals or Grievances filed against Contractor with DOI. The Contractor has timely filed all reports required by DOI and DOI has taken no adverse action against Contractor of which FAC the Finance has not been notified. As an HMO or Insurer insurer under Subtitle 3 of the Kentucky Insurance Code with a health line of authority, and regardless of the non-applicability of any other provision of the Kentucky Insurance Code or any legal authority cited herein, pursuant to this Contract the Contractor agrees to be subject to a one percent (1%) annual assessment on Capitation Payments capitation payments that follow the provisions of any broad based assessment within state law including but not limited to the Governor’s Enacted Budget, KRS 304.17B-021 or KRS 142.316, subject to the approval of CMS. The one percent (1%) assessment is a component of the Capitation Rates as contained in Appendix A “Capitation Payment Rates.” On or about March 1st of each year, the Department shall notify the Contractor in writing that the annual assessment is due and the Contractor shall have thirty (30) 30 calendar days to remit payment in full to the Department. In the event the assessment is increased, the increase shall be provided for in an amended Capitation Rate. If CMS fails to approve this component of the rates, or if the assessment is otherwise deemed non- non-collectable, the Capitation Payment capitation payment rates shall be adjusted to remove that component from the Capitation Rate.

Licensure of the Contractor. The Contractor has a valid license to operate as an HMO or Insurer, issued by DOI. There are no outstanding unresolved material Appeals or Grievances filed against Contractor with DOI. The Contractor has timely filed all reports required by DOI and DOI has taken no adverse action against Contractor of which FAC has not been notified. As an HMO or Insurer under Subtitle 3 of the Kentucky Insurance Code with a health line of authority, and regardless of the non-applicability of any other provision of the Kentucky Insurance Code or any legal authority cited herein, pursuant to this Contract the Contractor agrees to be subject to a one percent (1%) annual assessment on Capitation Payments that follow the provisions of any broad based assessment within state law including but not limited to the Governor’s Enacted Budget, KRS 304.17B-021 or KRS 142.316, subject to the approval of CMS. The one percent (1%) assessment is a component of the Capitation Rates as contained in Appendix A “Capitation Payment Rates.” On or about March 1st of each year, the Department shall notify the Contractor in writing that the annual assessment is due and the Contractor shall have thirty (30) calendar days to remit payment in full to the Department. In the event the assessment is increased, the increase shall be provided for in an amended Capitation Rate. If CMS fails to approve this component of the rates, or if the assessment is otherwise deemed non- non - collectable, the Capitation Payment rates shall be adjusted to remove that component from the Capitation Rate.