Prohibited Terminations. A covered QFC must require, after an affiliate of the direct party has become subject to a receivership, insolvency, liquidation, resolution, or similar proceeding,
Prohibited Terminations. Company shall not terminate this Agreement because Provider expresses disagreement with Company’s decision to deny or limit benefits to a Member or because Provider assists the Member to seek reconsideration of the Company’s decision; or because Provider discusses with a current, former, or prospective patient any aspect of the patient's medical condition, any proposed treatments or treatment alternatives, whether covered by Company or not, policy provisions of a plan, or Provider’s personal recommendation regarding selection of a health plan based on the Provider’s personal knowledge of the health needs of such patients. Nor shall Company terminate this Agreement or penalize Provider because (a) Provider filed a complaint or appeal as permitted by the New Jersey regulations governing health maintenance organizations; or (b) for acting as an advocate for the Member for seeking benefits for appropriate, medically necessary health services. Nevertheless, Provider is prohibited from making, publishing, disseminating, or circulating directly or indirectly or aiding, abetting, or encouraging the making, publishing, disseminating, or circulating of any oral or written statement or any pamphlet, circular, article, or literature that is false or maliciously critical of Company and calculated to injure Company. A material misrepresentation by Provider of the provisions, terms, or requirements of Company shall be a breach of this Agreement for which Company may exercise its rights of termination.
Prohibited Terminations. Company shall not terminate the Agreement because Provider expresses disagreement with Company’s decision to deny or limit benefits to a Member or because Provider assists the Member to seek reconsideration of the Company’s decision; or because Provider discusses with a current, former, or prospective patient any aspect of the patient's medical condition, any proposed treatments or treatment alternatives, whether covered by Company or not, policy provisions of Company or of a plan, or Provider’s personal recommendation regarding selection of a health plan based on the Provider’s personal knowledge of the health needs of such patients. Nor shall Company terminate the Agreement or penalize Provider because (a) Provider filed a complaint or appeal as permitted by the New Jersey regulations governing health maintenance organizations; or (b) for acting as an advocate for the Member for seeking benefits for appropriate, medically necessary health services. [NJA 11:24-15.2 (b) 2, (b) 3]. Nevertheless, Provider is prohibited from making, publishing, disseminating, or circulating directly or indirectly or aiding, abetting, or encouraging the making, publishing, disseminating, or circulating of any oral or written statement or any pamphlet, circular, article, or literature that is false or maliciously critical of Company and calculated to injure Company. A material misrepresentation by Provider of the provisions, terms, or requirements of Company shall be a breach of the Agreement for which Company may exercise its rights of termination. [State Contract Section 4.9.3.D.]
Prohibited Terminations. In case of a legal dispute as to a party’s right to exercise a default right under a covered QFC, the proposal would require that a covered QFC must provide that, after an affiliate of the direct party has entered a resolution proceeding, (a) the party seeking to exercise the default right bears the burden of proof that the exercise of that right is indeed 82 As discussed above, the FDI Act stays direct default rights against the failed depository institution but does not stay the exercise of cross-default rights against its affiliates. 83 Under the FDI Act, the relevant stay period runs until 5:00 p.m. (eastern time) on the business day following the appointment of the FDIC as receiver. 12 U.S.C. 1821(e)(10)(B)(I). 84 12 U.S.C. 1821(e)(9)–(10). 85 See proposed rule § 382.4(i). 86 See id. (noting that the general creditor protections in section 382.4(e), and the additional creditor protections for supported QFCs in section 382.4(g), are inapplicable to FDI Act proceedings). permitted by the covered QFC; and (b) the party seeking to exercise the default right must meet a “clear and convincing evidence” standard, a similar standard,87 or a more demanding standard. The purpose of this proposed requirement is to deter the QFC counterparty of a covered entity from thwarting the purpose of this proposal by exercising a default right because of an affiliate’s entry into resolution under the guise of other default rights that are unrelated to the affiliate’s entry into resolution. Agency transactions. In addition to entering into QFCs as principals, GSIBs may engage in QFCs as agents for other principals. For example, a GSIB subsidiary may enter into a master securities lending arrangement with a foreign bank as agent for a U.S.-based pension fund. The GSIB subsidiary would document its role as agent for the pension fund, often through an annex to the master agreement, and would generally provide to its customer (the principal party) a securities replacement guarantee or indemnification for any shortfall in collateral in the event of the default of the foreign bank.88 Similarly, a covered FSI may also enter into a QFC as agent acting on behalf of a principal. This proposal would apply to a covered QFC regardless of whether the covered FSI is acting as a principal or as an agent. Section 382.3 and section 382.4 do not distinguish between agents and principals with respect to default rights or transfer restrictions applicable to covered QFCs. Section 382.3 would lim...
