Common use of Rates and Payments Clause in Contracts

Rates and Payments. (a) Schedule of Rates. The rates for the Covered California for Small Business Plan Year 2024 and the annual update for Plan Years 2025 and 2026, are those rates submitted by Contractor during the Certification Process and subsequently uploaded and validated by Contractor through the SERFF Templates for each Plan Year. The parties acknowledge and agree that the premium rates for Covered California for Small Business are actuarially determined to assure that premium revenues and cost sharing contributions will provide the total dollar amount necessary to support (i) the provision of Covered Services by Contractor through its QDPs, (ii) administrative expenses and reasonable reserves by Contractor to meet the requirements outlined in this Agreement and in accordance with applicable laws, rules and regulations, and (iii) the payment by Contractor of the Participation Fee to Covered California. The Participation Fee payable with respect to Covered California Enrollees in Covered California for Small Business includes a fee specified by Covered California as necessary to support payment of distribution related expenses. Contractor acknowledges and agrees that any Participation Fees due to Covered California from Contractor shall be withheld by Covered California before passing through any premium payments received by Covered California from Employers and Employees to Contractor in accordance with paragraph (d) of this Section 6.1.1. (b) Updates. The Monthly Rates shall be established in accordance with the procedures set forth at Section 4.5. Covered California may authorize an update of rates no more frequently than on a quarterly basis in the Covered California for Small Business, in accordance with requirements and update schedules to be determined by Covered California.

Rates and Payments. (a) Schedule of Rates. The rates for the Covered California for Small Business Plan Year 2024 2023 and the annual update for Plan Years 2025 2024 and 20262025, are those rates submitted by Contractor during the Certification Process and subsequently uploaded and validated by Contractor through the SERFF Templates for each Plan Year. The parties acknowledge and agree that the premium rates for Covered California for Small Business are actuarially determined to assure that premium revenues and cost sharing contributions will provide the total dollar amount necessary to support (i) the provision of Covered Services by Contractor through its QDPs, (ii) administrative expenses and reasonable reserves by Contractor to meet the requirements outlined in this Agreement and in accordance with applicable laws, rules and regulations, and (iii) the Contractor’s payment by Contractor of the Participation Fee to Covered California. The Participation Fee payable with respect to Covered California Enrollees in Covered California for Small Business includes a fee specified by Covered California as necessary to support payment of distribution related expenses. Contractor acknowledges and agrees that any Participation Fees due to Covered California from Contractor shall be withheld by Covered California before passing through any premium payments received by Covered California from Employers and Employees to Contractor in accordance with paragraph (d) of this Section 6.1.15.2.1. (b) Updates. The Monthly Rates shall be established in accordance with the procedures set forth at Section 4.53.5. Covered California may authorize an update of rates no more frequently than on a quarterly basis in the Covered California for Small Business, in accordance with requirements and update schedules to be determined by Covered California.

Rates and Payments. (a) Schedule of Rates. The rates for the Covered California for Small Business Plan Year 2024 2023 and the annual update for Plan Years 2024 and 2025 and 2026, are those rates submitted by Contractor during the Certification Process and subsequently uploaded and validated by Contractor through the SERFF Templates for each Plan Year. The parties acknowledge and agree that the premium rates for Covered California for Small Business are actuarially determined to assure that premium revenues and cost sharing contributions will provide the total dollar amount necessary to support (i) the provision of Covered Services by Contractor through its QDPsQHPs, (ii) administrative expenses and reasonable reserves by Contractor to meet the requirements outlined in this Agreement and in accordance with applicable laws, rules rules, and regulations, and (iii) the Contractor’s payment by Contractor of the Participation Fee to Covered California. The Participation Fee payable with respect to Covered California Enrollees during each month of this Agreement shall be equal to 5.2 percent of the gross premium attributable to each Enrollee in Covered California Contractor’s QHP for Small Business includes such month. The Participation Fee is in addition to a fee specified by Covered California as necessary to support payment of distribution distribution-related expenses. Contractor acknowledges and agrees that any Participation Fees due to Covered California from Contractor shall be withheld by Covered California before passing through any premium payments received by Covered California from Employers and Employees to Contractor in accordance with paragraph (d) of this Section 6.1.1. (b) Updates. The Monthly Rates Should Covered California need to collect or refund any premiums, the Participation Fee shall be established calculated pursuant to the QHP Issuer Agreement that was in accordance with place during the procedures set forth at Section 4.5. Covered California may authorize an update of rates no more frequently than on a quarterly basis in the Covered California for Small Business, in accordance with requirements and update schedules to be determined by Covered Californiaapplicable Plan Year or years.

Rates and Payments. (a) Schedule of Rates. The rates for the Covered California for Small Business Plan Year 2024 2026 and the annual update for Plan Years 2025 2027 and 2026, 2028 are those rates submitted by Contractor during the Certification Process and subsequently uploaded and validated by Contractor through the SERFF Templates for each Plan Year. The parties acknowledge and agree that the premium rates for Covered California for Small Business are actuarially determined to assure that premium revenues and cost sharing contributions will provide the total dollar amount necessary to support (i) the provision of Covered Services by Contractor through its QDPsQHPs, (ii) administrative expenses and reasonable reserves by Contractor to meet the requirements outlined in this Agreement and in accordance with applicable laws, rules rules, and regulations, and (iii) the Contractor’s payment by Contractor of the Participation Fee to Covered California. The Participation Fee payable with respect to Covered California Enrollees during each month of this Agreement shall be equal to 5.2 percent of the gross premium attributable to each Enrollee in Covered California Contractor’s QHP for Small Business includes such month. The Participation Fee is in addition to a fee specified by Covered California as necessary to support payment of distribution distribution-related expenses. Contractor acknowledges and agrees that any Participation Fees due to Covered California from Contractor shall be withheld by Covered California before passing through any premium payments received by Covered California from Employers and Employees to Contractor in accordance with paragraph (d) of this Section 6.1.1. (b) Updates. The Monthly Rates Should Covered California need to collect or refund any premiums, the Participation Fee shall be established calculated pursuant to the QHP Issuer Agreement that was in accordance with place during the procedures set forth at Section 4.5. Covered California may authorize an update of rates no more frequently than on a quarterly basis in the Covered California for Small Business, in accordance with requirements and update schedules to be determined by Covered Californiaapplicable Plan Year or years.

Rates and Payments. (a) Schedule of Rates. The rates for the Covered California for Small Business Plan Year 2024 2026 and the annual update for Plan Years 2025 2027 and 202620262028, are those rates submitted by Contractor during the Certification Process and subsequently uploaded and validated by Contractor through the SERFF Templates for each Plan Year. The parties acknowledge and agree that the premium rates for Covered California for Small Business are actuarially determined to assure that premium revenues and cost sharing contributions will provide the total dollar amount necessary to support (i) the provision of Covered Services by Contractor through its QDPs, (ii) administrative expenses and reasonable reserves by Contractor to meet the requirements outlined in this Agreement and in accordance with applicable laws, rules and regulations, and (iii) the payment by Contractor of the Participation Fee to Covered California. The Participation Fee payable with respect to Covered California Enrollees in Covered California for Small Business includes a fee specified by Covered California as necessary to support payment of distribution related expenses. Contractor acknowledges and agrees that any Participation Fees due to Covered California from Contractor shall be withheld by Covered California before passing through any premium payments received by Covered California from Employers and Employees to Contractor in accordance with paragraph (d) of this Section 6.1.1. (b) Updates. The Monthly Rates shall be established in accordance with the procedures set forth at Section 4.5. Covered California may authorize an update of rates no more frequently than on a quarterly basis in the Covered California for Small Business, in accordance with requirements and update schedules to be determined by Covered California.

Rates and Payments. (a) Schedule of Rates. The rates for the Covered California for Small Business Plan Year 2024 2017 are set forth in Attachment 10 (“Monthly Rates - Covered California for Small Business”) and the annual update will be updated annually for Plan Years 2025 2018, 2019, 2020, and 2026, 2021 in Attachment 11 (“Rate Updates – Covered California for Small Business”). The Monthly Rates for Plan Year 2022 are those rates submitted by Contractor during the Certification Process and subsequently uploaded and validated by Contractor through the SERFF Templates for each the 2022 Plan Year. The parties acknowledge and agree that the premium rates for Covered California for Small Business are actuarially determined to assure that premium revenues and cost sharing contributions will provide the total dollar amount necessary to support (i) the provision of Covered Services by Contractor through its QDPsQHPs, (ii) administrative expenses and reasonable reserves by Contractor to meet the requirements outlined in this Agreement and in accordance with applicable laws, rules rules, and regulations, and (iii) the Contractor’s payment by Contractor of the Participation Fee to Covered California. The Participation Fee payable with respect to Covered California Enrollees during each month of this Agreement shall be equal to 5.2 percent of the gross premium attributable to each Enrollee in Covered California Contractor’s QHP for Small Business includes such month. The Participation Fee is in addition to a fee specified by Covered California as necessary to support payment of distribution distribution-related expenses. Contractor acknowledges and agrees that any Participation Fees due to Covered California from Contractor shall be withheld by Covered California before passing through any premium payments received by Covered California from Employers and Employees to Contractor in accordance with paragraph (d) of this Section 6.1.1. (b) Updates5.1.1. The Monthly Rates Should Covered California need to collect or refund any premiums for years 2014 to 2016, the Participation Fee shall be established calculated pursuant to the QHP Issuer Agreement that was in accordance with place during the procedures set forth at Section 4.5. Covered California may authorize an update of rates no more frequently than on a quarterly basis in the Covered California for Small Business, in accordance with requirements and update schedules to be determined by Covered Californiaapplicable Plan Year or years.