Common use of Patient-Centered Standard Benefit Designs Clause in Contracts

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.

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.

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 4 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.

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 4 6 — 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 Contractors are 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.

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.