RESPONSIBILITIES OF GROUP. 4.1. GROUP covenants and agrees that, at all times during the term of this Agreement and any extension thereof, it shall conduct all corporate activities required by its Articles of Incorporation and Bylaws, including but not limited to election of a Board of Directors, election of Officers, appointment of committee members including but not limited to the Quality and Utilization Management Committee. In addition, GROUP agrees to appoint a Medical Director. GROUP shall be solely responsible for payment of any and all compensation, payroll taxes, fringe benefits, disability insurance, workers’ compensation insurance and any other benefits of all such individuals.
4.2. GROUP shall not enter into any agreements with Participating Providers unless such Participating Providers have: (i) current unrestricted licenses to practice their respective professions in the State of California and (ii) current unrestricted Federal Drug Enforcement Agency (“DEA”) numbers. In addition, where GROUP contracts with individual physicians, such physicians shall have medical staff membership at the hospitals required by Participating Plans and where GROUP contracts with licensed clinics and medical groups, at least one primary care physician practicing at each clinic or medical group shall have medical staff membership at the hospitals required by Participating Plans. GROUP further agrees to establish procedures to ensure that Participating Providers meet these requirements on an ongoing basis. Manager shall reasonably cooperate with and assist GROUP to meet its obligations under this Section ; provided however, that GROUP acknowledges and agrees that it shall retain ultimate responsibility for meeting such obligations.
4.3. GROUP acknowledges and agrees that it is solely responsible for making all required reports to the Medical Board of California under Section 805 of the California Business and Professions Code and the National Practitioner Data Bank.
4.4. GROUP shall, at its sole cost and expense, procure and maintain at all times during the term of this Agreement comprehensive general and professional liability insurance covering all activities of GROUP directly or indirectly relating to GROUP, each policy in a minimum amount of $1,000,000.00 per occurrence and $3,000,000.00 in the aggregate. The aforedescribed comprehensive general and professional liability insurance shall be issued by a company or companies authorized to do business in California with a financial rating o...
RESPONSIBILITIES OF GROUP. Group agrees to:
A. Offer coverage to those eligible employees 26[and Covered Dependents], as described in Section IV above.
B. Provide notification to each Subscriber, within 15 days after termination of the Subscriber’s coverage, of the Subscriber’s right to convert to one of Our individual direct payment contracts, contingent upon the Subscriber having reasonable access to Our Service Area or convert to the Healthy New York Individual Program. Group is also responsible for providing COBRA notices to ineligible Subscribers.
C. Furnish to Us, on a monthly basis (or as otherwise required), on Our approved forms, such information as may reasonable be required by Us for the administration of the Agreement, including any change in a Member’s eligibility status. In addition, We may, at reasonable times, examine the Group’s pertinent records with respect to eligibility and Premium payments hereunder.
D. Comply with all policies and procedures established by Us in administering and interpreting the Agreement. This includes providing Oxford with the Re-certification Notice 27[at least 45] days prior to the renewal date.
RESPONSIBILITIES OF GROUP. (a) Initial Enrollment. Subject to any Open Enrollment Period and the effective date of this Contract, the Group shall offer to all of its Eligible Employees the opportunity to subscribe for themselves and their Dependents to the Benefit option(s) chosen by the Group in lieu of any other benefit plan(s) offered by the Group. New employees who become Eligible Employees will be given the opportunity to enroll themselves and any Dependents.
RESPONSIBILITIES OF GROUP. Group agrees to:
A. Offer coverage to eligible employees and their eligible family members, as described in Section IV above. It is agreed that eligible employees of the Group will be free to choose Our coverage or any other coverage as may be available through the Group during the initial and subsequent Group Open Enrollment Periods. Every eligible employee of the Group will be given a fair opportunity to elect one of the Group’s coverage options and will not be penalized by the Group because of his or her choice.
B. Offer each new employee the opportunity to elect Our coverage as a procedure of employment when he or she becomes an eligible employee as described in the Agreement.
C. Provide notification to each Member, within 15 days after termination of the Member’s coverage, of the Member’s right to convert to one of Our individual direct payment contracts, contingent upon the Member having reasonable access to Our Service Area.
D. Furnish to Us, on a monthly basis (or as otherwise required), on Our approved forms, such information as may reasonable be required by Us for the administration of the Agreement, including any change in a Member’s eligibility status. In addition, We may, at reasonable times, examine the Group’s pertinent records with respect to eligibility and Premium payments hereunder.
E. Comply with all policies and procedures established by Us in administering and interpreting the Agreement.
RESPONSIBILITIES OF GROUP. 5.1 Throughout the term of this Agreement, Group shall:
(i) collect and keep on file Patient’s Authorization to Release Patient Information; and
(ii) use Group’s best efforts to regularly update the Portal with accurate information.
RESPONSIBILITIES OF GROUP. 2.1. Group covenants and agrees that, at all times during the term of this Agreement and any extension thereof, it shall conduct all activities required by its Group Agreement. In addition, Group agrees to appoint a Medical Director. Group shall be solely responsible for payment of any and all compensation, payroll taxes, fringe benefits, disability insurance, workers’ compensation insurance and any other benefits of such Medical Director.
2.2. Group shall not enter into any agreements with Participating Providers unless such Participating Providers have: (i) current unrestricted licenses to practice their respective professions in the State of California and (ii) current unrestricted Federal Drug Enforcement Agency (“DEA”) numbers. In addition, where Group contracts with individual physicians, such physicians shall have medical staff membership at the hospitals required by Health Plan and where Group contracts with licensed clinics and medical groups, at least one primary care physician practicing at each clinic or medical Group shall have medical staff membership at the hospitals required by Participating Plans. Group further agrees to establish policies that Manager can carry out to ensure that Participating Providers meet these requirements on an ongoing basis.
2.3. Group acknowledges and agrees that it is solely responsible for making all required reports to the Medical Board of California under Section 805 of the California Business and Professions Code and the National Practitioner Data Bank.
2.4. Group shall, at its sole cost and expense, procure and maintain at all times during the term of this Agreement comprehensive general and professional liability insurance coverage for all activities of Group directly or indirectly relating to Group. Each policy in a minimum amount of $1,000,000 per occurrence and $3,000,000 in the aggregate. The aforedescribed comprehensive general and professional liability insurance shall be issued by a company or companies authorized to do business in California with a financial rating of at least A:12 or better in “Best’s Key Rating Guide” or its equivalent. In the event Group procures a “claims made” policy as distinguished from an “occurrence” policy, Group shall procure and maintain at its sole cost and expense, prior to termination of such insurance, “tail” coverage to continue and extend coverage complying with this Agreement after the end of the “claims made” policy. Upon reasonable request from Manager, Group sha...
RESPONSIBILITIES OF GROUP. Group agrees to:
A. Offer coverage to those eligible employees 30[and Covered Dependents], as described in Section IV above.
B. Provide notification to each Member, within 15 days after termination of the Member’s coverage, of the Member’s right to convert to one of Our individual direct payment contracts, contingent upon the Member having reasonable access to Our Service Area or convert to the Healthy New York Individual Program.
C. Furnish to Us, on a monthly basis (or as otherwise required), on Our approved forms, such information as may reasonable be required by Us for the administration of the Agreement, including any change in a Member’s eligibility status. In addition, We may, at reasonable times, examine the Group’s pertinent records with respect to eligibility and Premium payments hereunder.
D. Comply with all policies and procedures established by Us in administering and interpreting the Agreement. This includes providing Oxford with the Re-certification Notice 31[at least 45] days prior to the renewal date.
RESPONSIBILITIES OF GROUP
