Common use of PAYMENTS TO COUNTY Clause in Contracts

PAYMENTS TO COUNTY. A. CAPITATION RATES In consideration of full compliance by the County with contract requirements, the Department agrees to pay the County monthly payments based on the capitation rate specified and subject to the conditions of this Contract. The capitation rate shall not include any amount for recoupment of losses incurred by the County under previous Contracts nor does it include services that are not covered under the State Plan. B. ACTUARIAL BASIS OF CAPITATION RATE The capitation rate is calculated on an actuarial basis recognizing the payment limits set forth in federal law 42 CFR 438.6(c). C. RENEGOTIATION The monthly capitation rates set forth in this article are recalculated on an annual basis. The County will have 30 calendar days from the date of the written notification to accept the new capitation rates in writing or to initiate termination or non-renewal of the Contract. The capitation rates are not subject to renegotiation once they have been accepted, unless such renegotiation is required by changes in federal or state laws, rules or regulations. X. XXXXXXXXXXX The County may obtain a risk-sharing arrangement from an insurer other than the Department for coverage of enrollees under this Contract, provided that the County remains substantially at risk for providing services under this Contract. E. RESPONSIBILITY TO PROVIDE SERVICES The County is responsible for the provision of Contract and administrative services covered under this Contract from the date the recipient is enrolled in the County, regardless of whether or not the County receives a capitation payment for that recipient for the initial month pursuant to the conditions agreed upon. F. PAYMENT SCHEDULE Capitation payments to the County shall be based on County Enrollment Reports, which the Department will transmit to the County. Payment for each person listed as an ADD or CONTINUE on County Enrollment Reports shall be made within 134 days of the date the report is generated. G. COORDINATION OF BENEFITS (COB) The County must actively pursue, collect and retain all monies from all available resources for services to enrollees covered under this Contract except where the amount of reimbursement the County can reasonably expect to receive is less than the estimated cost of recovery. COB recoveries will be done by post-payment billing (pay and chase) for certain preventive pediatric services. Post-payment billing will also be done in situations where the third party liability is derived from a parent whose obligation to pay is being enforced by the State Child Support Enforcement Agency and the provider has not received payment within 30 days after the date of service. 1. Cost effectiveness of recovery is determined by, but not limited to time, effort, and capital outlay required to perform the activity. The County must be able to specify the threshold amount or other guidelines used in determining whether to seek reimbursement from a liable third party, or describe the process by which the County determines seeking reimbursement would not be cost effective, upon request of the Department. 2. To assure compliance, records shall be maintained by the County of all COB collections and reports shall be made annually on the form designated by the Department. The County must be able to demonstrate that appropriate collection efforts and appropriate recovery actions were pursued. The Department has the right to review all billing histories and other data related to COB activities for enrollees. The County must seek from all enrollees information on other available resources. a. Other available resources may include, but are not limited to, all other state or federal medical care programs which are primary to Medicaid, group or individual health insurance, ERISAs, service benefit plans, the insurance of absent parents who may have insurance to pay medical care for spouses or minor enrollees, and subrogation/workers compensation collections. b. Subrogation collections are any recoverable amounts arising out of settlement of personal injury, medical malpractice, product liability, or Worker’s Compensation. State subrogation rights have been extended to the County under s. 49.89(9), Act 31, Laws of 1989. After attorneys’ fees and expenses have been paid, the County shall collect the full amount paid on behalf of the enrollee. 3. Section 1912(b) of the Social Security Act must be construed in a beneficiary-specific manner. The purpose of the distribution provision is to permit the beneficiary to retain TPL benefits to which he or she is entitled to except to the extent that Medicaid (or the County on behalf of Medicaid) is reimbursed for its costs. The County is free, within the constraints of state law and this Contract; to make whatever case it can to recover the costs it incurred on behalf of its enrollee. It can use the Medicaid fee schedule, an estimate of what a capitated physician would charge on a fee-for-service basis, the value of the care provided in the market place or some other acceptable proxy as the basis of recovery. However, any excess recovery, over and above the cost of care (however the County chooses to define that cost) must be returned to the beneficiary. Counties may not collect from amounts allotted to the beneficiary in a judgment or court-approved settlement. The County is to follow the practices outlined in the DHFS Casualty Recovery Manual. 4. Where the County has entered a risk-sharing arrangement with the Department, the COB collection and distribution shall follow the procedures described in this Contract. Act 27; Laws of 1995 extended assignment rights to HMOs under s. 632.72. 5. COB collections are the responsibility of the County or its subcontractors. Subcontractors must report COB information to the County. County and subcontractors shall not pursue collection from the enrollee but directly from the third party payer. Access to medical services will not be restricted due to COB collection. 6. The following requirement shall apply if the Contractor (or the Contractor’s parent firm and/or any subdivision or subsidiary of either the Contractor’s parent firm or of the Contractor) is a health care insurer (including, but not limited to, a group health insurer and/or health maintenance organization) licensed by the Wisconsin Office of the Commissioner of Insurance and/or a third-party administrator for a group or individual health insurer(s), health maintenance organization(s), and/or employer self-insurer health plan(s): a. Throughout the Contract term, these insurers and third-party administrators shall comply in full with the provision of subsection

PAYMENTS TO COUNTY. A. CAPITATION RATES In RATES----In consideration of full compliance by the County with contract Contract requirements, the Department agrees to pay the County monthly payments based on the capitation rate specified and subject to the conditions of this Contract. The capitation rate shall not include any amount for recoupment of losses incurred by the County under previous Contracts nor does it include services that are not covered under the State Plan. B. ACTUARIAL BASIS OF CAPITATION RATE The RATE----The capitation rate is calculated on an actuarial basis recognizing the payment limits set forth in federal law 42 CFR 438.6(c). C. RENEGOTIATION RENEGOTIATION---- The monthly capitation rates set forth in this article are recalculated on an annual basis. The County will have 30 calendar days from the date of the written notification to accept the new capitation rates in writing or to initiate termination or non-renewal of the Contract. The capitation rates are not subject to renegotiation once they have been accepted, unless such renegotiation is required by changes in federal or state laws, rules or regulations. X. XXXXXXXXXXX The D. REINSURANCE----The County may obtain a risk-sharing arrangement from an insurer other than the Department for coverage of enrollees members under this Contract, provided that the County remains substantially at risk for providing services under this Contract. E. RESPONSIBILITY TO PROVIDE SERVICES The SERVICES----The County is responsible for the provision of Contract and administrative services covered under this Contract from the date the recipient member is enrolled in the County, regardless of whether or not the County receives a capitation payment for that recipient member for the initial month pursuant to the conditions agreed upon. F. PAYMENT SCHEDULE Capitation SCHEDULE----Capitation payments to the County shall be based on County Enrollment Reports, which the Department will transmit to the County. Payment for each person listed as an ADD or CONTINUE on County Enrollment Reports shall be made within 134 days of the date the report is generated. G. COORDINATION OF BENEFITS (COB) The COB)----The County must actively pursue, collect and retain all monies from all available resources for services to enrollees members covered under this Contract except where the amount of reimbursement the County can reasonably expect to receive is less than the estimated cost of recovery. COB recoveries will be done by post-payment billing (pay and chase) for certain preventive pediatric services. Post-payment billing will also be done in situations where the third party liability is derived from a parent whose obligation to pay is being enforced by the State state Child Support Enforcement Agency and the provider has not received payment within 30 days after the date of service. 1. Cost effectiveness of recovery is determined by, but not limited to time, effort, and capital outlay required to perform the activity. The County must be able to specify the threshold amount or other guidelines used in determining whether to seek reimbursement from a liable third party, or describe the process by which the County determines seeking reimbursement would not be cost effective, upon request of the Department. 2. To assure compliance, records shall be maintained by the County of all COB collections and reports shall be made annually on the form designated by the Department. The County must be able to demonstrate that appropriate collection efforts and appropriate recovery actions were pursued. The Department has the right to review all billing histories and other data related to COB activities for enrollees. The County must seek from all enrollees information on other available resources. a. Other available resources may include, but are not limited to, all other state or federal medical care programs which are primary to Medicaid, group or individual health insurance, ERISAs, service benefit plans, the insurance of absent parents who may have insurance to pay medical care for spouses or minor enrollees, and subrogation/workers compensation collections. b. Subrogation collections are any recoverable amounts arising out of settlement of personal injury, medical malpractice, product liability, or Worker’s Compensation. State subrogation rights have been extended to the County under s. 49.89(9), Act 31, Laws of 1989. After attorneys’ fees and expenses have been paid, the County shall collect the full amount paid on behalf of the enrollee. 3. Section 1912(b) of the Social Security Act must be construed in a beneficiary-specific manner. The purpose of the distribution provision is to permit the beneficiary to retain TPL benefits to which he or she is entitled to except to the extent that Medicaid (or the County on behalf of Medicaid) is reimbursed for its costs. The County is free, within the constraints of state law and this Contract; to make whatever case it can to recover the costs it incurred on behalf of its enrollee. It can use the Medicaid fee schedule, an estimate of what a capitated physician would charge on a fee-for-service basis, the value of the care provided in the market place or some other acceptable proxy as the basis of recovery. However, any excess recovery, over and above the cost of care (however the County chooses to define that cost) must be returned to the beneficiary. Counties may not collect from amounts allotted to the beneficiary in a judgment or court-approved settlement. The County is to follow the practices outlined in the DHFS Casualty Recovery Manual. 4. Where the County has entered a risk-sharing arrangement with the Department, the COB collection and distribution shall follow the procedures described in this Contract. Act 27; Laws of 1995 extended assignment rights to HMOs under s. 632.72. 5. COB collections are the responsibility of the County or its subcontractors. Subcontractors must report COB information to the County. County and subcontractors shall not pursue collection from the enrollee but directly from the third party payer. Access to medical services will not be restricted due to COB collection. 6. The following requirement shall apply if the Contractor (or the Contractor’s parent firm and/or any subdivision or subsidiary of either the Contractor’s parent firm or of the Contractor) is a health care insurer (including, but not limited to, a group health insurer and/or health maintenance organization) licensed by the Wisconsin Office of the Commissioner of Insurance and/or a third-party administrator for a group or individual health insurer(s), health maintenance organization(s), and/or employer self-insurer health plan(s): a. Throughout the Contract term, these insurers and third-party administrators shall comply in full with the provision of subsection

PAYMENTS TO COUNTY. A. CAPITATION RATES In consideration of full compliance by the County with contract Contract requirements, the Department agrees to pay the County monthly payments based on the capitation rate specified and subject to the conditions of this Contract. The capitation rate shall not include any amount for recoupment of losses incurred by the County under previous Contracts nor does it include services that are not covered under the State Plan. B. ACTUARIAL BASIS OF CAPITATION RATE The capitation rate is calculated on an actuarial basis recognizing the payment limits set forth in federal law 42 CFR 438.6(c). C. RENEGOTIATION The monthly capitation rates set forth in this article are recalculated on an annual basis. The County will have 30 calendar days from the date of the written notification to accept the new capitation rates in writing or to initiate termination or non-renewal of the Contract. The capitation rates are not subject to renegotiation once they have been accepted, unless such renegotiation is required by changes in federal or state laws, rules or regulations. X. XXXXXXXXXXX The County may obtain a risk-sharing arrangement from an insurer other than the Department for coverage of enrollees under this Contract, provided that the County remains substantially at risk for providing services under this Contract. E. RESPONSIBILITY TO PROVIDE SERVICES The County is responsible for the provision of Contract and administrative services covered under this Contract from the date the recipient is enrolled in the County, regardless of whether or not the County receives a capitation payment for that recipient for the initial month pursuant to the conditions agreed upon. F. PAYMENT SCHEDULE Capitation payments to the County shall be based on County Enrollment Reports, which the Department will transmit to the County. Payment for each person listed as an ADD or CONTINUE on County Enrollment Reports shall be made within 134 days of the date the report is generated. G. COORDINATION OF BENEFITS (COB) The County must actively pursue, collect and retain all monies from all available resources for services to enrollees covered under this Contract except where the amount of reimbursement the County can reasonably expect to receive is less than the estimated cost of recovery. COB recoveries will be done by post-payment billing (pay and chase) for certain preventive pediatric services. Post-payment billing will also be done in situations where the third party liability is derived from a parent whose obligation to pay is being enforced by the State state Child Support Enforcement Agency and the provider has not received payment within 30 days after the date of service. 1. Cost effectiveness of recovery is determined by, but not limited to time, effort, and capital outlay required to perform the activity. The County must be able to specify the threshold amount or other guidelines used in determining whether to seek reimbursement from a liable third party, or describe the process by which the County determines seeking reimbursement would not be cost effective, upon request of the Department. 2. To assure compliance, records shall be maintained by the County of all COB collections and reports shall be made annually on the form designated by the Department. The County must be able to demonstrate that appropriate collection efforts and appropriate recovery actions were pursued. The Department has the right to review all billing histories and other data related to COB activities for enrollees. The County must seek from all enrollees enrollees’ information on other available resources. a. Other available resources may include, but are not limited to, all other state or federal medical care programs which are primary to Medicaid, group or individual health insurance, ERISAs, service benefit plans, the insurance of absent parents who may have insurance to pay medical care for spouses or minor enrollees, and subrogation/workers compensation collections. b. Subrogation collections are any recoverable amounts arising out of settlement of personal injury, medical malpractice, product liability, or Worker’s Compensation. State subrogation rights have been extended to the County under s. 49.89(9), Act 31, Laws of 1989. After attorneys’ fees and expenses have been paid, the County shall collect the full amount paid on behalf of the enrollee. 3. Section 1912(b) of the Social Security Act must be construed in a beneficiary-specific manner. The purpose of the distribution provision is to permit the beneficiary to retain TPL benefits to which he or she is entitled to except to the extent that Medicaid (or the County on behalf of Medicaid) is reimbursed for its costs. The County is free, within the constraints of state law and this Contract; to make whatever case it can to recover the costs it incurred on behalf of its enrollee. It can use the Medicaid fee schedule, an estimate of what a capitated physician would charge on a fee-for-service basis, the value of the care provided in the market place marketplace or some other acceptable proxy as the basis of recovery. However, any excess recovery, over and above the cost of care (however the County chooses to define that cost) must be returned to the beneficiary. Counties may not collect from amounts allotted to the beneficiary in a judgment or court-approved settlement. The County is to follow the practices outlined in the DHFS Casualty Recovery Manual. 4. Where the County has entered a risk-sharing arrangement with the Department, the COB collection and distribution shall follow the procedures described in this Contract. Act 27; Laws of 1995 extended assignment rights to HMOs counties under s. 632.72. 5. COB collections are the responsibility of the County or its subcontractors. Subcontractors must report COB information to the County. County and subcontractors shall not pursue collection from the enrollee but directly from the third party payer. Access to medical services will not be restricted due to COB collection. 6. The following requirement shall apply if the Contractor (or the Contractor’s parent firm and/or any subdivision or subsidiary of either the Contractor’s parent firm or of the Contractor) is a health care insurer (including, but not limited to, a group health insurer and/or health maintenance organization) licensed by the Wisconsin Office of the Commissioner of Insurance and/or a third-party administrator for a group or individual health insurer(s), health maintenance organization(s), and/or employer self-insurer health plan(s): a. Throughout the Contract term, these insurers and third-party administrators shall comply in full with the provision of subsection

PAYMENTS TO COUNTY. A. CAPITATION RATES In consideration of full compliance by the County with contract requirements, the Department agrees to pay the County monthly payments based on the capitation rate specified and subject to the conditions of this Contract. The capitation rate shall not include any amount for recoupment of losses incurred by the County under previous Contracts nor does it include services that are not covered under the State Plan. B. ACTUARIAL BASIS OF CAPITATION RATE The capitation rate is calculated on an actuarial basis recognizing the payment limits set forth in federal law 42 CFR 438.6(c). C. RENEGOTIATION The monthly capitation rates set forth in this article are recalculated on an annual basis. The County will have 30 calendar days from the date of the written notification to accept the new capitation rates in writing or to initiate termination or non-renewal of the Contract. The capitation rates are not subject to renegotiation once they have been accepted, unless such renegotiation is required by changes in federal or state laws, rules or regulations. X. XXXXXXXXXXX D. REINSURANCE The County may obtain a risk-sharing arrangement from an insurer other than the Department for coverage of enrollees members under this Contract, provided that the County remains substantially at risk for providing services under this Contract. E. RESPONSIBILITY TO PROVIDE SERVICES The County is responsible for the provision of Contract and administrative services covered under this Contract from the date the recipient is enrolled in the County, regardless of whether or not the County receives a capitation payment for that recipient for the initial month pursuant to the conditions agreed upon. F. PAYMENT SCHEDULE Capitation payments to the County shall be based on County Enrollment Reports, which the Department will transmit to the County. Payment for each person listed as an ADD or CONTINUE on County Enrollment Reports shall be made within 134 days of the date the report is generated. G. COORDINATION OF BENEFITS (COB) The County must actively pursue, collect and retain all monies from all available resources for services to enrollees members covered under this Contract except where the amount of reimbursement the County can reasonably expect to receive is less than the estimated cost of recovery. COB recoveries will be done by post-payment billing (pay and chase) for certain preventive pediatric services. Post-payment billing will also be done in situations where the third party liability is derived from a parent whose obligation to pay is being enforced by the State Child Support Enforcement Agency and the provider has not received payment within 30 days after the date of service. 1. Cost effectiveness of recovery is determined by, but not limited to time, effort, and capital outlay required to perform the activity. The County must be able to specify the threshold amount or other guidelines used in determining whether to seek reimbursement from a liable third party, or describe the process by which the County determines seeking reimbursement would not be cost effective, upon request of the Department. 2. To assure compliance, records shall be maintained by the County of all COB collections and reports shall be made annually on the form designated by the Department. The County must be able to demonstrate that appropriate collection efforts and appropriate recovery actions were pursued. The Department has the right to review all billing histories and other data related to COB activities for enrolleesmembers. The County must seek from all enrollees members information on other available resources. a. Other available resources may include, but are not limited to, all other state or federal medical care programs which are primary to Medicaid, group or individual health insurance, ERISAs, service benefit plans, the insurance of absent parents who may have insurance to pay medical care for spouses or minor enrolleesmembers, and subrogation/workers compensation collections. b. Subrogation collections are any recoverable amounts arising out of settlement of personal injury, medical malpractice, product liability, or Worker’s Compensation. State subrogation rights have been extended to the County under s. 49.89(9), Act 31, Laws of 1989. After attorneys’ fees and expenses have been paid, the County shall collect the full amount paid on behalf of the enrolleemember. 3. Section 1912(b) of the Social Security Act must be construed in a beneficiary-specific manner. The purpose of the distribution provision is to permit the beneficiary to retain TPL benefits to which he or she is entitled to except to the extent that Medicaid (or the County on behalf of Medicaid) is reimbursed for its costs. The County is free, within the constraints of state law and this Contract; to make whatever case it can to recover the costs it incurred on behalf of its enrolleemember. It can use the Medicaid fee schedule, an estimate of what a capitated physician would charge on a fee-for-service basis, the value of the care provided in the market place or some other acceptable proxy as the basis of recovery. However, any excess recovery, over and above the cost of care (however the County chooses to define that cost) must be returned to the beneficiary. Counties may not collect from amounts allotted to the beneficiary in a judgment or court-approved settlement. The County is to follow the practices outlined in the DHFS DHS Casualty Recovery Manual. 4. Where the County has entered a risk-sharing arrangement with the Department, the COB collection and distribution shall follow the procedures described in this Contract. Act 27; Laws of 1995 extended assignment rights to HMOs special managed care programs under s. 632.72. 5. COB collections are the responsibility of the County or its subcontractors. Subcontractors must report COB information to the County. County and subcontractors shall not pursue collection from the enrollee member but directly from the third party payer. Access to medical services will not be restricted due to COB collection. 6. The following requirement shall apply if the Contractor (or the Contractor’s parent firm and/or any subdivision or subsidiary of either the Contractor’s parent firm or of the Contractor) is a health care insurer (including, but not limited to, a group health insurer and/or health maintenance organization) licensed by the Wisconsin Office of the Commissioner of Insurance and/or a third-party administrator for a group or individual health insurer(s), health maintenance organization(s), and/or employer self-insurer health plan(s): a. Throughout the Contract term, these insurers and third-party administrators shall comply in full with the provision of subsection

PAYMENTS TO COUNTY. A. CAPITATION RATES In consideration of full compliance by the County with contract Contract requirements, the Department agrees to pay the County monthly payments based on the capitation rate specified and subject to the conditions of this Contract. The capitation rate shall not include any amount for recoupment of losses incurred by the County under previous Contracts nor does it include services that are not covered under the State Plan. B. ACTUARIAL BASIS OF CAPITATION RATE The capitation rate is calculated on an actuarial basis recognizing the payment limits set forth in federal law 42 CFR 438.6(c). C. RENEGOTIATION The monthly capitation rates set forth in this article are recalculated on an annual basis. The County will have 30 calendar days from the date of the written notification to accept the new capitation rates in writing or to initiate termination or non-renewal of the Contract. The capitation rates are not subject to renegotiation once they have been accepted, unless such renegotiation is required by changes in federal or state laws, rules or regulations. X. XXXXXXXXXXX D. REINSURANCE The County may obtain a risk-sharing arrangement from an insurer other than the Department for coverage of enrollees members under this Contract, provided that the County remains substantially at risk for providing services under this Contract. E. RESPONSIBILITY TO PROVIDE SERVICES The County is responsible for the provision of Contract and administrative services covered under this Contract from the date the recipient is enrolled in the County, regardless of whether or not the County receives a capitation payment for that recipient for the initial month pursuant to the conditions agreed upon. F. PAYMENT SCHEDULE Capitation payments to the County shall be based on County Enrollment Reports, which the Department will transmit to the County. Payment for each person listed as an ADD or CONTINUE on County Enrollment Reports shall be made within 134 days of the date the report is generated. G. COORDINATION OF BENEFITS (COB) The County must actively pursue, collect and retain all monies from all available resources for services to enrollees members covered under this Contract except where the amount of reimbursement the County can reasonably expect to receive is less than the estimated cost of recovery. COB recoveries will be done by post-payment billing (pay and chase) for certain preventive pediatric services. Post-payment billing will also be done in situations where the third party liability is derived from a parent whose obligation to pay is being enforced by the State state Child Support Enforcement Agency and the provider has not received payment within 30 days after the date of service. 1. Cost effectiveness of recovery is determined by, but not limited to time, effort, and capital outlay required to perform the activity. The County must be able to specify the threshold amount or other guidelines used in determining whether to seek reimbursement from a liable third party, or describe the process by which the County determines seeking reimbursement would not be cost effective, upon request of the Department. 2. To assure compliance, records shall be maintained by the County of all COB collections and reports shall be made annually on the form designated by the Department. The County must be able to demonstrate that appropriate collection efforts and appropriate recovery actions were pursued. The Department has the right to review all billing histories and other data related to COB activities for enrolleesmembers. The County must seek from all enrollees members’ information on other available resources. a. Other available resources may include, but are not limited to, all other state or federal medical care programs which are primary to Medicaid, group or individual health insurance, ERISAs, service benefit plans, the insurance of absent parents who may have insurance to pay medical care for spouses or minor enrolleesmembers, and subrogation/workers compensation collections. b. Subrogation collections are any recoverable amounts arising out of settlement of personal injury, medical malpractice, product liability, or Worker’s Compensation. State subrogation rights have been extended to the County under s. 49.89(9), Act 31, Laws of 1989. After attorneys’ fees and expenses have been paid, the County shall collect the full amount paid on behalf of the enrolleemember. 3. Section 1912(b) of the Social Security Act must be construed in a beneficiary-specific manner. The purpose of the distribution provision is to permit the beneficiary to retain TPL benefits to which he or she is entitled to except to the extent that Medicaid (or the County on behalf of Medicaid) is reimbursed for its costs. The County is free, within the constraints of state law and this Contract; to make whatever case it can to recover the costs it incurred on behalf of its enrolleemember. It can use the Medicaid fee schedule, an estimate of what a capitated physician would charge on a fee-for-service basis, the value of the care provided in the market place marketplace or some other acceptable proxy as the basis of recovery. However, any excess recovery, over and above the cost of care (however the County chooses to define that cost) must be returned to the beneficiary. Counties may not collect from amounts allotted to the beneficiary in a judgment or court-approved settlement. The County is to follow the practices outlined in the DHFS DHS Casualty Recovery Manual. 4. Where the County has entered a risk-sharing arrangement with the Department, the COB collection and distribution shall follow the procedures described in this Contract. Act 27; Laws of 1995 extended assignment rights to HMOs counties under s. 632.72. 5. COB collections are the responsibility of the County or its subcontractors. Subcontractors must report COB information to the County. County and subcontractors shall not pursue collection from the enrollee member but directly from the third party payer. Access to medical services will not be restricted due to COB collection. 6. The following requirement shall apply if the Contractor (or the Contractor’s parent firm and/or any subdivision or subsidiary of either the Contractor’s parent firm or of the Contractor) is a health care insurer (including, but not limited to, a group health insurer and/or health maintenance organization) licensed by the Wisconsin Office of the Commissioner of Insurance and/or a third-party administrator for a group or individual health insurer(s), health maintenance organization(s), and/or employer self-insurer health plan(s): a. Throughout the Contract term, these insurers and third-party administrators shall comply in full with the provision of subsection