Prohibited Terminations Clause Samples
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:
(1) The party seeking to exercise a default right to bear the burden of
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