Common use of Service Area Eligibility Clause in Contracts

Service Area Eligibility. In order to facilitate the Exchange’s compliance with State and Federal law, Contractor shall monitor information it receives directly, or indirectly or through its subcontractors to assure continued compliance with eligibility requirements related to: (i) participation by Employers in Covered California for Small Business, including, those requirements related to the Employer’s principal place of business or primary worksite in the Service Area, or (ii) participation of Qualified Individuals in the Individual Exchange, including requirements related to residency in the Contractor’s service area. Contractor shall notify the Exchange if it becomes aware that an Employer or individual Enrollee enrolled in a QHP of Contractor no longer meets the requirements for eligibility, based on place of business, primary worksite or residence. The Exchange will evaluate, or cause CalHEERS to evaluate, such information to determine Enrollee’s continuing enrollment in the Contractor’s Service Area under the Exchange’s policies which shall be established in accordance with applicable laws, rules and regulations. Contractor and its subcontractors will have no duty to investigate representations made by Employers regarding eligibility; provided, however, that Contractor shall notify the Exchange in the event that it becomes aware that such representation may not be accurate.

Appears in 3 contracts

Samples: Qualified Health Plan Issuer Contract, Qualified Health Plan Issuer Contract, Qualified Health Plan Issuer Contract

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Service Area Eligibility. In order to facilitate the Exchange’s compliance with State and Federal law, Contractor shall monitor information it receives directly, directly or indirectly or through its subcontractors to assure ensure continued compliance with eligibility requirements related to: (i) participation by Employers in Covered California for Small Business, including, including those requirements related to the Employer’s principal place of business or primary worksite in the Service Area, Area or (ii) participation of Qualified Individuals in the Individual Exchange, including requirements related to residency in the Contractor’s service area. Contractor shall notify the Exchange if it becomes aware that an Employer or individual Enrollee enrolled in a QHP QDP of Contractor no longer meets the requirements for eligibility, based on place of business, primary worksite worksite, or residence. The Exchange will evaluate, or cause CalHEERS to evaluate, such information to determine Enrollee’s continuing enrollment in the Contractor’s Service Area under the Exchange’s policies which shall be established in accordance with applicable laws, rules and regulations. Contractor and its subcontractors will have no duty to investigate representations made by Employers regarding eligibility; provided, however, that Contractor shall notify the Exchange in the event that it becomes aware that such representation may not be accurate.

Appears in 2 contracts

Samples: Qualified Dental Plan Issuer Contract, Qualified Dental Plan Issuer Contract

Service Area Eligibility. In order to facilitate the Exchange’s compliance with State and Federal law, Contractor shall monitor information it receives directly, or indirectly or through its subcontractors to assure ensure continued compliance with eligibility requirements related to: (i) participation by Employers in Covered California for Small Business, including, including those requirements related to the Employer’s principal place of business or primary worksite in the Service Area, Area or (ii) participation of Qualified Individuals in the Individual Exchange, including requirements related to residency in the Contractor’s service area. Contractor shall notify the Exchange if it becomes aware that an Employer or individual Enrollee enrolled in a QHP QDP of Contractor no longer meets the requirements for eligibility, based on place of business, primary worksite or residence. The Exchange will evaluate, or cause CalHEERS to evaluate, such information to determine Enrollee’s continuing enrollment in the Contractor’s Service Area under the Exchange’s policies which shall be established in accordance with applicable laws, rules and regulations. Contractor and its subcontractors will have no duty to investigate representations made by Employers regarding eligibility; provided, however, that Contractor shall notify the Exchange in the event that it becomes aware that such representation may not be accurate.

Appears in 2 contracts

Samples: Qualified Dental Plan Issuer Contract, Qualified Dental Plan Issuer Contract

Service Area Eligibility. In order to facilitate the Exchange’s Exchange¶s compliance with State and Federal law, Contractor shall monitor information it receives directly, or indirectly or through its subcontractors to assure ensure continued compliance with eligibility requirements related to: (i) participation by Employers in Covered California for Small Business, including, those requirements related to the Employer’s Employer¶s principal place of business or primary worksite in the Service Area, Area or (ii) participation of Qualified Individuals in the Individual Exchange, including including, requirements related to residency in the Contractor’s Contractor¶s service area. Contractor shall notify the Exchange if it becomes aware that an Employer or individual Enrollee enrolled in a QHP QDP of Contractor no longer meets the requirements for eligibility, based on place of business, primary worksite or residence. The Exchange will evaluate, or cause CalHEERS to evaluate, such information to determine Enrollee’s Enrollee¶s continuing enrollment in the Contractor’s Contractor¶s Service Area under the Exchange’s Exchange¶s policies which shall be established in accordance with applicable laws, rules and regulations. Contractor and its subcontractors will have no duty to investigate representations made by Employers regarding eligibility; provided, however, that Contractor shall notify the Exchange in the event that it becomes aware that such representation may not be accurate.

Appears in 1 contract

Samples: Qualified Dental Plan Issuer Contract

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Service Area Eligibility. In order to facilitate the Exchange’s compliance with State and Federal law, Contractor shall monitor information it receives directly, or indirectly or through its subcontractors to assure ensure continued compliance with eligibility requirements related to: (i) participation by Employers in Covered California for Small Business, including, ,including those requirements related to the Employer’s principal place of business or primary worksite in the Service Area, Area or (ii) participation of Qualified Individuals in the Individual Exchange, including,including requirements related to residency in the Contractor’s service area. Contractor shall notify the Exchange if it becomes aware that an Employer or individual Enrollee enrolled in a QHP QDP of Contractor no longer meets the requirements for eligibility, based on place of business, primary worksite or residence. The Exchange will evaluate, or cause CalHEERS to evaluate, such information to determine Enrollee’s continuing enrollment in the Contractor’s Service Area under the Exchange’s policies which shall be established in accordance with applicable laws, rules and regulations. Contractor and its subcontractors will have no duty to investigate representations made by Employers regarding eligibility; provided, however, that Contractor shall notify the Exchange in the event that it becomes aware that such representation may not be accurate.

Appears in 1 contract

Samples: Covered California Qualified Dental Plan Issuer Contract

Service Area Eligibility. In order to facilitate the Exchange’s compliance with State and Federal law, Contractor shall monitor information it receives directly, or indirectly or through its subcontractors to assure ensure continued compliance with eligibility requirements related to: (i) participation by Employers in Covered California for Small Business, including, those requirements related to the Employer’s principal place of business or primary worksite in the Service Area, Area or (ii) participation of Qualified Individuals in the Individual Exchange, including including, requirements related to residency in the Contractor’s service area. Contractor shall notify the Exchange if it becomes aware that an Employer or individual Enrollee enrolled in a QHP QDP of Contractor no longer meets the requirements for eligibility, based on place of business, primary worksite or residence. The Exchange will evaluate, or cause CalHEERS to evaluate, such information to determine Enrollee’s continuing enrollment in the Contractor’s Service Area under the Exchange’s policies which shall be established in accordance with applicable laws, rules and regulations. Contractor and its subcontractors will have no duty to investigate representations made by Employers regarding eligibility; provided, however, that Contractor shall notify the Exchange in the event that it becomes aware that such representation may not be accurate.

Appears in 1 contract

Samples: Qualified Dental Plan Issuer Contract

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