Common use of Member Cost-Sharing Clause in Contracts

Member Cost-Sharing. As specified in OAC rules 5160-26-05 and 5160-26-12, the MCP is permitted to impose the applicable member co-payment amount for dental services, vision services, non-emergency emergency department services, or prescribed drugs, the MCP shall notify ODM if they intend to impose a co-payment. ODM shall approve the notice to be sent to the MCP’s members and the timing of when the co-payments will begin to be imposed. If ODM determines the MCP’s decision to impose a particular co-payment on their members would constitute a significant change for those members, ODM may require the effective date of the co-payment to coincide with the “Open Enrollment” month. Notwithstanding the preceding paragraph, the MCP shall provide an ODM-approved notice to all their members 90 calendar days in advance of the date that the MCP will impose the co- payment. With the exception of member co-payments the MCP has elected to implement in accordance with OAC rules 5160-26-05 and 5160-26-12, the MCP’s payment constitutes payment in full for any covered services and their subcontractors shall not charge members or ODM any additional co-payment, cost sharing, down-payment, or similar charge, refundable or otherwise.

Member Cost-Sharing. As specified in OAC rules 5160-26-05 and 5160-26-12, the MCP is MCPs are permitted to impose the applicable member co-payment amount for dental services, vision services, non-emergency emergency department services, or prescribed drugs, the MCP shall MCPs must notify ODM if they intend to impose a co-payment. ODM shall must approve the notice to be sent to the MCP’s members and the timing of when the co-payments will begin to be imposed. If ODM determines the that an MCP’s decision to impose a particular co-payment on their members would constitute a significant change for those members, ODM may require the effective date of the co-payment to coincide with the “Open Enrollment” month. Notwithstanding the preceding paragraph, the MCP shall MCPs must provide an ODM-approved notice to all their members 90 calendar days in advance of the date that the MCP will impose the co- payment. With the exception of member co-payments the MCP has elected to implement in accordance with OAC rules 5160-26-05 and 5160-26-12, the MCP’s payment constitutes payment in full for any covered services and their subcontractors shall must not charge members or ODM any additional co-payment, cost sharing, down-down- payment, or similar charge, refundable or otherwise.