Common use of Member Financial Protections Clause in Contracts

Member Financial Protections. County and its Subcontractors shall comply with Member financial protections as follows: 5.7.1 County agrees to indemnify and hold Members harmless from all efforts to seek compensation and any claims for compensation from Members for Covered Services under this Contract. In no event shall a Member be liable to County for any amounts which are owed by, or are the obligation of, CalOptima. 5.7.2 In no event, including, but not limited to, non-payment by CalOptima, CalOptima’s or County’s insolvency, or breach of this contract by CalOptima, shall County Associates, bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against the State of California or any Member or person acting on behalf of a Member for Covered Services pursuant to this Contract. Notwithstanding the foregoing, County Associates may collect Share of Cost (SOC), co-payments, and deductibles if, and to the extent, required under a specific CalOptima Program and applicable law. 5.7.3 This provision does not prohibit County Associates from billing and collecting payment for non-Covered Services if the CalOptima Member agrees to the payment in writing prior to the actual delivery of non-Covered Services and a copy of such agreement is given to the Member and placed in the Member’s medical record prior to rendering such services. 5.7.4 Upon receiving notice of CountyAssociate’s invoicing or balance billing a Member for the difference between the County’s billed charges and the reimbursement paid by CalOptima for any Covered Services, CalOptima may sanction the County or take other action as provided in this Contract. 5.7.5 This section shall survive the termination of this Contract for Covered Services furnished to CalOptima Members prior to the termination of this Contract, regardless of the cause giving rise to termination, and shall be construed to be for the benefit of Members. This section shall supersede any oral or written contrary agreement now existing or hereafter entered into between the County and its Subcontractors. Language to ensure the foregoing shall be included in all of County’s Subcontracts related to provision of Covered Services to CalOptima Members. 5.7.6 County shall hold harmless both the State and Members in the event that CalOptima cannot or will not pay for services performed by the County pursuant to the Contract.

Member Financial Protections. County and its Subcontractors shall comply with Member financial protections as follows: 5.7.1 County agrees to indemnify and hold Members harmless from all efforts to seek compensation and any claims for compensation from Members for Covered Services under this Contract. In no event shall a Member be liable to County for any amounts which are owed by, or are the obligation of, CalOptima. 5.7.2 In no event, including, but not limited to, non-payment by CalOptima, CalOptima’s or County’s insolvency, or breach of this contract by CalOptima, shall County Associates, bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against the State of California or any Member or person acting on behalf of a Member for Covered Services pursuant to this Contract. Notwithstanding the foregoing, County Associates may collect Share of Cost (SOC), co-payments, and deductibles if, and to the extent, required under a specific CalOptima Program and applicable law. 5.7.3 This provision does not prohibit County Associates from billing and collecting payment for non-Covered Services if the CalOptima Member agrees to the payment in writing prior to the actual delivery of non-Covered Services and a copy of such agreement is given to the Member and placed in the Member’s medical record prior to rendering such services. 5.7.4 Upon receiving notice of CountyAssociateCounty Associate’s invoicing or balance billing a Member for the difference between the County’s billed charges and the reimbursement paid by CalOptima for any Covered Services, CalOptima may sanction the County or take other action as provided in this Contract. 5.7.5 This section shall survive the termination of this Contract for Covered Services furnished to CalOptima Members prior to the termination of this Contract, regardless of the cause giving rise to termination, and shall be construed to be for the benefit of Members. This section shall supersede any oral or written contrary agreement now existing or hereafter entered into between the County and its Subcontractors. Language to ensure the foregoing shall be included in all of County’s Subcontracts related to provision of Covered Services to CalOptima Members. 5.7.6 County shall hold harmless both the State and Members in the event that CalOptima cannot or will not pay for services performed by the County pursuant to the Contract. 5.7.7 County agrees to hold Members harmless and not liable for Medicare Part A and B cost sharing when the State and/or DHCS is responsible for paying such amounts. County may not impose cost-sharing that exceeds the amount of cost-sharing that would be permitted with respect to the Member under Title XIX if the Member were not enrolled in OneCare Connect. County will: 1) Accept CalOptima payment as payment in full, or 2) Bill the appropriate State source.” 4. Section 9.1 shall be deleted in its entirety and replaced with the following new Section 9.1:

Member Financial Protections. County and its Subcontractors shall comply with Member financial protections as follows: 5.7.1 5.6.1 County agrees to indemnify and hold Members harmless from all efforts to seek compensation and any claims for compensation from Members for Covered Services under this Contract. In no event shall a Member be liable to County for any amounts which are owed by, or are the obligation of, CalOptima. 5.7.2 5.6.2 In no event, including, but not limited to, non-payment by CalOptima, CalOptima’s or County’s insolvency, or breach of this contract by CalOptima, shall County AssociatesCounty, billxxxx, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against the State of California or any Member or person acting on behalf of a Member for Covered Services pursuant to this Contract. Notwithstanding the foregoing, County Associates may collect Share of Cost (SOC), co-payments, and deductibles if, and to the extent, required under a specific CalOptima Program and applicable law. 5.7.3 5.6.3 This provision does not prohibit County Associates from billing and collecting payment for non-Covered Services if the CalOptima Member agrees to the payment in writing prior to the actual delivery of non-Covered Services and a copy of such agreement is given to the Member and placed in the Member’s medical record prior to rendering such services. 5.7.4 5.6.4 Upon receiving notice of CountyAssociate’s County invoicing or balance billing a Member for the difference between the County’s billed charges and the reimbursement paid by CalOptima for any Covered Services, CalOptima may sanction the County or take other action as provided in this Contract. 5.7.5 5.6.5 This section shall survive the termination of this Contract for Covered Services furnished to CalOptima Members prior to the termination of this Contract, regardless of the cause giving rise to termination, and shall be construed to be for the benefit of Members. This section shall supersede any oral or written contrary agreement now existing or hereafter entered into between the County and its Subcontractors. Language to ensure the foregoing shall be included in all of County’s Subcontracts related to provision of Covered Services to CalOptima Members. 5.7.6 County shall hold harmless both the State and Members in the event that CalOptima cannot or will not pay for services performed by the County pursuant to the Contract.

Member Financial Protections. County and its Subcontractors shall comply with Member financial protections as follows: 5.7.1 County agrees to indemnify and hold Members harmless from all efforts to seek compensation and any claims for compensation from Members for Covered Services under this Contract. In no event shall a Member be liable to County for any amounts which are owed by, or are the obligation of, CalOptima. 5.7.2 In no event, including, but not limited to, non-payment by CalOptima, CalOptima’s 's or County’s 's insolvency, or breach of this contract by CalOptima, shall County Associates, billxxxx, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against the State of California or any Member or person acting on behalf of a Member for Covered Services pursuant to this Contract. Notwithstanding the foregoing, County Associates may collect Share of Cost (SOC), co-payments, and deductibles if, and to the extent, required under a specific CalOptima Program and applicable law. 5.7.3 This provision does not prohibit County Associates from billing and collecting payment for non-Covered Services if the CalOptima Member agrees to the payment in writing prior to the actual delivery of non-Covered Services and a copy of such agreement is given to the Member and placed in the Member’s 's medical record prior to rendering such services. 5.7.4 Upon receiving notice of CountyAssociate’s ofCountyAssociate's invoicing or balance billing a Member for the difference between the County’s 's billed charges and the Orange County Health Care Agency- Public Health Coordination and Provision of Public Health Care Services Contract Medi-Cal June 1,2013 reimbursement paid by CalOptima for any Covered Services, CalOptima may sanction the County or take other action as provided in this Contract. 5.7.5 This section shall survive the termination of this Contract for Covered Services furnished to CalOptima Members prior to the termination of this Contract, regardless of the cause giving rise to termination, and shall be construed to be for the benefit of Members. This section shall supersede any oral or written contrary agreement now existing or hereafter entered into between the County and its Subcontractors. Language to ensure the foregoing shall be included in all of County’s 's Subcontracts related to provision of Covered Services to CalOptima Members. 5.7.6 County shall hold harmless both the State and Members in the event that CalOptima cannot or will not pay for services performed by the County pursuant to the Contract.