Patient-Centered Standard Benefit Designs Sample Clauses

Patient-Centered Standard Benefit Designs. During the term of this Agreement, Contractor shall ensure its QDPs provide the benefits and services at the cost-sharing and actuarial cost levels described in the Covered California Patient-Centered Benefit Plan Designs as approved by the Board for the applicable Plan Year, and as may be amended from time to time as required under applicable laws, rules and regulations or as otherwise authorized under this Agreement.
Sample 1Sample 2Sample 3See All (13)
AutoNDA by SimpleDocs
Patient-Centered Standard Benefit Designs a) During the term of this Agreement, Contractor shall ensure its QHPs provide the benefits and services at the cost-sharing and actuarial cost levels described in the Covered California Patient-Centered Benefit Plan Designs as approved by the Board for the applicable Plan Year. Contractor must notify and receive approval from Covered California for deviations from the Patient-Centered Benefit Plan Designs during the annual certification process. Covered California may approve, on a case-by-case basis, Contractor's request to deviate from the Board approved Patient-Centered Standard Benefit Plan Designs during the term of this Agreement. b) During the term of this Agreement, for any Plan Year that the cost of the cost-sharing reduction program is built into the premium for Contractor’s Silver-level QHPs, Contractor shall offer a non-mirrored Silver-level plan, that is not a QHP, outside of Covered California that complies with the benefits and services at the cost-sharing and actuarial cost level described in the plan design at Attachment 5 — Silver 70 Off-Exchange Plan, Non-Mirrored Silver Plan Design. This plan must not have any rate increase or cost attributable to the cost of the cost-sharing reduction program. c) Contractor is encouraged to propose innovations in benefit design to Covered California, understanding truly beneficial innovations are likely to be incorporated into the standard benefit design, thus benefiting all Enrollees, not just the Contractor’s. New proposals must be submitted far enough in advance of the Board establishing each year’s benefit designs to allow for adequate review by Covered California for consideration as a potential addition to the standard benefit design. Consumer incentive programs should be considered benefit designs for this purpose.
Sample 1Sample 2Sample 3See All (11)
Patient-Centered Standard Benefit Designs a) During the term of this Agreement, Contractor shall ensure its QHPs provide the benefits and services at the cost-sharing and actuarial cost levels described in the Covered California Patient-Centered Benefit Plan Designs as approved by the Board for the applicable Plan Year. b) In addition to standardized benefit designs, Contractor may submit alternate benefit designs (ABD) for Contractor’s licensed geographic service area. Alternate benefit designs are optional. Alternate benefit designs must comply with state statutory and regulatory requirements. The alternate benefit design offering should incorporate the commission rate guidance utilized for all Covered California for Small Business plans.
Sample 1Sample 2Sample 3See All (7)
Patient-Centered Standard Benefit Designs a) During the term of this Agreement, Contractor shall ensure its QHPs provide the benefits and services at the cost-sharing and actuarial cost levels described in the Covered California Patient-Centered Benefit Plan Designs as approved by the Board for the applicable Plan Year. Contractor must notify and receive approval from Covered California for deviations from the Patient-Centered Benefit Plan Designs during the annual certification process. Covered California may approve, on a case-by-case basis, Contractor's request to deviate from the Board approved Patient-Centered Standard Benefit Plan Designs during the term of this Agreement. b) During the term of this Agreement, for any Plan Year that the cost of the cost-sharing reduction program is built into the premium for Contractor’s Silver-level QHPs, Contractor shall offer a non-mirrored Silver-level plan, that is not a QHP, outside of Covered California that complies with the benefits and services at the cost-sharing and actuarial cost level described in the plan design at Attachment 3 (“Silver 70 Off-Exchange Plan, Non-Mirrored Silver Plan Design”). This plan must not have any rate increase or cost attributable to the cost of the cost-sharing reduction program.
Sample 1Sample 2See All (5)

Related to Patient-Centered Standard Benefit Designs

  • Public Benefits ‌ 5.1 Developer to provide Public Benefits‌ The Developer must, at its cost and risk, provide the Public Benefits to the City in accordance with this document.

  • Restricted Employment for Certain State Personnel Contractor acknowledges that, pursuant to Section 572.069 of the Texas Government Code, a former state officer or employee of a state agency who during the period of state service or employment participated on behalf of a state agency in a procurement or contract negotiation involving Contractor may not accept employment from Contractor before the second anniversary of the date the Contract is signed or the procurement is terminated or withdrawn.

  • Covered Services You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.

  • Covered Benefits Benefits for Bone Mass Measurement for the prevention, diagnosis, and treatment of osteoporosis are covered when requested by a Health Care Provider for a Qualified Individual.

  • Health Benefits For the eighteen (18) month period following the Termination Date, provided that Executive is eligible for, and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretion.

  • Medical Benefits The Company shall reimburse the Employee for the cost of the Employee's group health, vision and dental plan coverage in effect until the end of the Termination Period. The Employee may use this payment, as well as any other payment made under this Section 6, for such continuation coverage or for any other purpose. To the extent the Employee pays the cost of such coverage, and the cost of such coverage is not deductible as a medical expense by the Employee, the Company shall "gross-up" the amount of such reimbursement for all taxes payable by the Employee on the amount of such reimbursement and the amount of such gross-up.

  • Educational Benefits 19.01 Employees who enrol in courses at the College are entitled to a remission of one hundred percent (100%) of the tuition fees and all of the application fees with respect to one full course per academic year. Educational benefits are prorated for part-time employees. 19.02 The spouse and dependent children (not employed by the Employer) of an employee are entitled to a fee remission of fifty percent (50%) of the appropriate tuition fees. Educational benefits are prorated for part-time employees.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!