Rates/Premiums Clause Samples

The Rates/Premiums clause defines the specific amounts or formulas used to calculate the payments required under an agreement, typically in the context of insurance or service contracts. It outlines how much the party must pay, how often payments are due, and may specify conditions under which rates or premiums can change, such as annual adjustments or changes in risk factors. This clause ensures both parties have a clear understanding of the financial obligations involved, reducing the risk of disputes over payment amounts and providing predictability in budgeting and contract performance.
Rates/Premiums. Subject to the Sanctions provisions of this Section, HCA will pay a monthly premium for each Enrollee in full consideration of the work to be performed by the Contractor under this Contract. HCA will pay the Contractor, on or before the fifteenth (15th) calendar day of the month based on the HCA list of Enrollees whose enrollment is ongoing or effective on the first day of said calendar month. Such payment will be denied for new Enrollees when, and for so long as, payment for those Enrollees is denied by the Centers for Medicare and Medicaid Services (CMS) under 42 C.F.R. § 438.726(b) or 42 C.F.R. § 438.730(e).
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Rates/Premiums. 4.1.1 Subject to the provisions of Section 12.31, Sanctions, HCA shall pay a monthly premium for each enrollee in full consideration of the work to be performed by the Contractor under this Contract. HCA shall pay the Contractor, on or before the fifteenth (15th) working day of the month based on the HCA list of enrollees whose enrollment is ongoing or effective on the first day of said calendar month. Such payment will be denied for new enrollees when, and for so long as, payment for those enrollees is denied by the Centers for Medicare and Medicaid Services (CMS) under 42 CFR 438.726(b) and 42 CFR 438.730(e). 4.1.2 The Contractor shall reconcile the electronic benefit enrollment listing with the premium payment information and submit a claim to DSHS for any amount due the Contractor within three hundred sixty-five (365) calendar days of the month of service. When DSHS’ records confirm the Contractor’s claim, DSHS shall remit payment within thirty (30) calendar days of the receipt of the claim. 4.1.3 The statewide Base Rate, Geographical Adjustment Factors, Risk Adjustment Factors and Age/Sex Factors are in Exhibit A, Premiums and Service Areas. 4.1.4 DSHS determines the BH premiums. The monthly premium payment will be calculated as follows: Premium Payment = Base Rate x Age/Sex Factor x Risk Adjustment Factor x Geographical Adjustment Factor as described herein. 4.1.5 Within sixty (60) calendar days following the end of the annual legislative session, DSHS will publish the Base Rate for the following calendar year. If the Contractor will not continue to provide HO/SCHIP services in the following calendar year, the Contractor shall so notify DSHS no later than September 2, of the current year under the provisions of Section 12.26
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Rates/Premiums. ‌ 5.1.1 Subject to the Sanctions provisions of this Section, HCA shall pay a monthly premium for each enrollee in full consideration of the work to be performed by the Contractor under this Contract. HCA shall pay the Contractor, on or before the fifteenth (15th) calendar day of the month based on HCA list of enrollees whose enrollment is ongoing or effective on the first day of said calendar month. Such payment will be denied for new enrollees when, and for so long as, payment for those enrollees is denied by the Centers for Medicare and Medicaid Services (CMS) under 42 C.F.R. § 438.726(b) or 42 C.F.R. § 438.730(e). 5.1.2 The Contractor shall reconcile the electronic benefit enrollment file with the premium payment information and submit differences it finds to HCA for resolution within sixty (60) calendar days of the first day of the subject month.
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Rates/Premiums. 5.1.1 Subject to the Sanctions provisions of this Section, HCA shall pay a monthly premium for each Enrollee under this Contract in full consideration of the work to be performed by the Contractor under this Contract. HCA will only pay monthly premium payments for Enrollees under this Contract in the eligible client groups detailed in Subsection 4.3 of this Contract. HCA shall pay the Contractor, on or before the fifteenth calendar day of the month based on HCA list of Enrollees whose enrollment is ongoing or effective on the first day of said calendar month.
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Rates/Premiums. 5.1.1 Subject to the Sanctions provisions of this Section, HCA shall pay a monthly premium for each enrollee in full consideration of the work to be performed by the Contractor under this Contract. HCA shall pay the Contractor, on or before the fifteenth (15th) calendar day of the month based on HCA list of enrollees whose enrollment is ongoing or effective on the first day of said calendar month. Such payment will be denied for new enrollees when, and for so long as, payment for those enrollees is denied by the Centers for Medicare and Medicaid Services (CMS) under 42 CFR 438.726(b) or 42 CFR 438.730(e). 5.1.2 The Contractor shall reconcile the electronic benefit enrollment file with the premium payment information and submit differences it finds to HCA for resolution within sixty (60) calendar days of the first day of the subject month. 5.1.3 HCA will make a reasonable effort to provide the Contractor program specific premiums for any renewal period one hundred and twenty (120) calendar days prior to the beginning of that renewal period. If the Contractor will not continue to provide services to HCA in the renewal period, the Contractor shall notify HCA no later than thirty (30) calendar days after the publication of the rates and factors as required under the Notices provisions of the General Terms and Conditions Section of this Contract. If the Contractor notifies HCA, this Contract shall terminate, without penalty to either party, effective midnight at the end of the current term of the Contract. Neither party shall have the right to assert a claim for costs.
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Rates/Premiums. 5.1.1 Subject to the Sanctions provisions of this Section, HCA shall pay a monthly premium for each enrollee, in full consideration of the work to be performed by the Contractor under this Contract. 5.1.2 HCA shall pay the Contractor, on or before the fifteenth (15th) working day of the month based on the HCA list of enrollees whose enrollment is ongoing or effective on the first day of said calendar month. Such payment will be denied for new enrollees when, and for so long as, payment for those enrollees is denied by the Centers for Medicare and Medicaid Services (CMS) under 42 C.F.R. 438.726(b) or 42 C.F.R. 438.730(e). 5.1.3 The Contractor shall reconcile the electronic benefit enrollment file with the premium payment information and submit differences it finds to HCA for resolution within sixty (60) calendar days of the first day of the subject month. 5.1.4 HCA shall make a full monthly payment to the Contractor for the month in which an enrollee's enrollment is terminated except as otherwise provided herein. 5.1.5 The Contractor shall be responsible for contracted services provided to the enrollee in any month for which HCA paid the Contractor for the enrollee's care under the terms of this Contract. 5.1.6 HCA shall establish separate rate cells for enrollees who are placed in a Long Term Acute Care (LTAC) Hospital.
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Related to Rates/Premiums

  • Increase in Insurance Premiums If an increase in any insurance premiums paid by Landlord for the Building is caused by Tenant's use of the Premises or if Tenant vacates the Premises and causes an increase in such premiums, then Tenant shall pay as additional rent the amount of such increase to Landlord.

  • Shift Premiums (a) All employees who are required by the Employer to rotate over two (2) or more shifts shall receive a shift premium of thirty cents ($0.30) for each hour worked on the afternoon or evening shifts only. Shift premium will not be paid for any hour in which an employee receives overtime premium and shift premium will not form part of the employee's straight time hourly rate. (b) In no event shall there be any pyramiding of benefits or payments.

  • Insurance Premiums Tenant shall pay or cause to be paid all premiums for the insurance coverage required to be maintained pursuant to Article 9.

  • Insurance Costs (08/19) Contractor shall be financially responsible for all premiums, deductibles, self-insured retentions, and self-insurance.

  • Maximum Charges In no event whatsoever shall interest and other charges charged hereunder exceed the highest rate permissible under law. In the event interest and other charges as computed hereunder would otherwise exceed the highest rate permitted under law, such excess amount shall be first applied to any unpaid principal balance owed by Borrowers, and if the then remaining excess amount is greater than the previously unpaid principal balance, Lenders shall promptly refund such excess amount to Borrowers and the provisions hereof shall be deemed amended to provide for such permissible rate.