Common use of Offerings Outside of Covered California Clause in Contracts

Offerings Outside of Covered California. a) Contractor acknowledges and agrees that as required under State and Federal law, QHPs and plans that are identical in benefits, service area, and cost sharing structure offered by Contractor outside Covered California must be offered at the same premium rate whether offered inside Covered California or outside Covered California directly from the Contractor or through an Agent. b) To the extent that Contractor intends to offer and sell new health products in the individual market outside of Covered California that are not the required offering of identical benefits described in Section 4.2.3 (a), Contractor shall notify Covered California of its intention to do so at least 90 Days prior to filing such products with the applicable regulator. Such notice must include the proposed network of providers, benefit designs, service area, and any unique features of these products. c) In the event that Contractor sells products outside Covered California, Contractor shall fairly and affirmatively offer, market, and sell all products made available to individuals in Covered California to individuals seeking coverage outside Covered California consistent with California law. d) For purposes of this section, “product” does not include contracts entered into pursuant to Part 6.2 (commencing with § 12693) of Division 2 of the Insurance Code between the Department of Health Care Services (DHCS) and health care service plans for Healthy Families beneficiaries or to contracts entered into pursuant to Chapter 7 (commencing with § 14000) of, or Chapter 8 (commencing with §14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the DHCS and health care service plans for enrolled Medi-Cal beneficiaries.

Offerings Outside of Covered California. a) Contractor acknowledges and agrees that as required under State and Federal law, QHPs and plans that are identical in benefits, service area, and cost sharing structure offered by Contractor outside Covered California must be offered at the same premium rate whether offered inside Covered California or outside Covered California directly from the Contractor or through an Agent. b) To the extent that Contractor intends to offer and sell new health products in the individual market outside of Covered California that are not the required offering of identical benefits described in Section 4.2.3 (a), Contractor shall notify Covered California of its intention to do so at least 90 ninety (90) Days prior to filing such products with the applicable regulator. Such notice must include the proposed network of providers, benefit designs, service area, and any unique features of these products. c) In the event that Contractor sells products outside Covered California, Contractor shall fairly and affirmatively offer, market, and sell all products made available to individuals in Covered California to individuals seeking coverage outside Covered California consistent with California law. d) For purposes of this section, “product” does not include contracts entered into pursuant to Part 6.2 (commencing with § 12693) of Division 2 of the Insurance Code between the Department of Health Care Services (DHCS) and health care service plans for Healthy Families beneficiaries or to contracts entered into pursuant to Chapter 7 (commencing with § 14000) of, or Chapter 8 (commencing with §14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the DHCS and health care service plans for enrolled Medi-Cal beneficiaries.

Offerings Outside of Covered California. ‌ a) Contractor acknowledges and agrees that as required under State and Federal law, QHPs and plans that are identical in benefits, service area, and cost sharing structure offered by Contractor outside Covered California must be offered at the same premium rate whether offered inside Covered California or outside Covered California directly from the Contractor or through an Agent. b) To the extent that Contractor intends to offer and sell new health products in the individual market outside of Covered California that are not the required offering of identical benefits described in Section 4.2.3 (a), Contractor shall notify Covered California of its intention to do so at least 90 ninety (90) Days prior to filing such products with the applicable regulatorState Regulator. Such notice must include the proposed network of providers, benefit designs, service area, and any unique features of these products. c) In the event that Contractor sells products outside Covered California, Contractor shall fairly and affirmatively offer, market, and sell all products made available to individuals in Covered California to individuals seeking coverage outside Covered California consistent with California law. d) For purposes of this section, “product” does not include contracts entered into pursuant to Part 6.2 (commencing with § 12693) of Division 2 of the Insurance Code between the Department of Health Care Services (DHCS) and health care service plans for Healthy Families beneficiaries or to contracts entered into pursuant to Chapter 7 (commencing with § 14000) of, or Chapter 8 (commencing with §14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the DHCS and health care service plans for enrolled Medi-Cal beneficiaries.

Offerings Outside of Covered California. ‌ a) Contractor acknowledges and agrees that as required under State and Federal law, QHPs and plans that are identical in benefits, service area, and cost sharing structure offered by Contractor outside Covered California must be offered at the same premium rate whether offered inside Covered California or outside Covered California directly from the Contractor or through an Agent. b) To the extent that Contractor intends to offer and sell new health products in the individual market outside of Covered California that are not the required offering of identical benefits described in Section 4.2.3 (a), Contractor shall notify Covered California of its intention to do so at least 90 ninety (90) Days prior to filing such products with the applicable regulator. Such notice must include the proposed network of providers, benefit designs, service area, and any unique features of these products. c) In the event that Contractor sells products outside Covered California, Contractor shall fairly and affirmatively offer, market, and sell all products made available to individuals in Covered California to individuals seeking coverage outside Covered California consistent with California law. d) For purposes of this section, “product” does not include contracts entered into pursuant to Part 6.2 (commencing with § 12693) of Division 2 of the Insurance Code between the Department of Health Care Services (DHCS) and health care service plans for Healthy Families beneficiaries or to contracts entered into pursuant to Chapter 7 (commencing with § 14000) of, or Chapter 8 (commencing with §14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the DHCS and health care service plans for enrolled Medi-Cal beneficiaries.