Premiums for Covered California for Small Business. Covered California for Small Business will be responsible for collection of premiums, including delinquent payments. Premium charged in Covered California for Small Business includes the assessment of the participation fee, as well as a percentage for distribution related expenses. Distribution related expenses shall be set at a rate as set forth in Attachment 3. Covered California for Small Business shall collect a percentage of the premium in order to compensate Agents and General Agents. Contractor acknowledges that Covered California for Small Business may have excess funds as a result of collecting a percentage of Enrollee premiums for distribution related expenses. In no event shall Covered California for Small Business be required to remit excess funds to Contractor. Any excess funds shall belong to Covered California for Small Business. Contractor shall review and reconcile information received from Covered California on a monthly basis relating to the administration of premium payments, including information required under 45 C.F.R. § 155.705 and other applicable laws, rules and regulations necessary to the administration of premiums. Such reconciliation process will include the Contractor’s review of information relating to the receipt of premium amounts due to Covered California from each Employer and Employee in Covered California for Small Business. Contractor shall provide Covered California notice of any reconciling enrollment information with premium payment information, which shall be evaluated by Covered California in consultation with Contractor. Contractor shall not be entitled to collect from Enrollees or receive from Employers any amounts or receive funds from the Employers above the premium amounts except with respect to cost-sharing amounts or to the extent that such payment (i) is expressly authorized under the QDPs, such as out-of- network services that comply with the notice requirements set forth at Section 3.4.3, or (ii) relates to a charge for non-sufficient funds or transaction fees initiated by Enrollee at rates that are reasonable and customary for such transactions; the Contractor shall not pursue collections of any said fees or unpaid premiums from Covered California.
Premiums for Covered California for Small Business. Covered California for Small Business will be responsible for collection of premiums, including delinquent payments. Premium charged in Covered California for Small Business includes the assessment of the participation fee, agent and general agent commissions (see Section 5.1.3 Participation Fee). Contractor shall review and reconcile information received from the Exchange on a monthly basis relating to the administration of premium payments, including information required under 45 C.F.R. § 155.705 and other applicable laws, rules and regulations necessary to the administration of premiums. Such reconciliation process will include the Contractor’s review of information relating to the receipt of premium amounts due to the Exchange from each Employer and Employee in Covered California for Small Business. Contractor shall provide the Exchange notice of any reconciling enrollment information with premium payment information, which shall be evaluated by the Exchange in consultation with Contractor. Contractor shall not be entitled to collect from Enrollees and/or receive from Employers any amounts or receive funds from the Employers above the premium amounts except with respect to cost-sharing amounts or to the extent that such payment (i) is expressly authorized under the QDPs, such as out-of- network services that comply with the notice requirements set forth at Section 3.4.3, or (ii) relates to a charge for non-sufficient funds or transaction fees initiated by Enrollee at rates that are reasonable and customary for such transactions; the Contractor shall not pursue collections of any said fees from the Exchange.
