Common use of Schedule of Rates Clause in Contracts

Schedule of Rates. The rates for the Covered California for Small Business Plan Year 2017 are set forth in Attachment 10 (“Monthly Rates - Covered California for Small Business”) and will be updated annually for Plan Years 2018, 2019, 2020, and 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 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 QHPs, (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 of the Participation Fee to Covered California. The Participation Fee payable to Covered California during each month of this Agreement shall be equal to 5.2 percent of the gross premium attributable to each Enrollee in Contractor’s QHP for such month. The Participation Fee is in addition to a fee specified by Covered California as necessary to support 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 5.1.1. Should Covered California need to collect or refund any premiums for years 2014 to 2016, the Participation Fee shall be calculated pursuant to the QHP Issuer Agreement that was in place during the applicable Plan Year or years.

Schedule of Rates. The rates for the Covered California for Small Business Plan Year 2017 are set forth in Attachment 10 (“Monthly Rates - Covered California for Small Business”) and will be updated annually for Plan Years 2018, 2019, 2020, and 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 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 QHPs, (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 of the Participation Fee to Covered California. The Participation Fee payable to Covered California during each month of this Agreement shall be equal to 5.2 percent of the gross premium attributable to each Enrollee in Contractor’s QHP for such month. The Participation Fee is in addition to a fee specified by Covered California as necessary to support 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 5.1.1. Should Covered California need to collect or refund any premiums for years 2014 to 2016, the Participation Fee shall be calculated pursuant to the QHP Issuer Agreement that was in place during the applicable Plan Year or years.