Common use of Service Area Eligibility Clause in Contracts

Service Area Eligibility. In order to facilitate Covered California’s compliance with State and Federal law, Contractor shall monitor information it receives directly or indirectly or through its subcontractors to 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 or (ii) participation of Qualified Individuals in the Covered California for the Individual Market, including requirements related to residency in Contractor’s service area. Contractor shall notify Covered California if it becomes aware that an Employer or individual Enrollee enrolled in a QDP of Contractor no longer meets the requirements for eligibility, based on place of business, primary worksite, or residence. Covered California will evaluate, or cause CalHEERS to evaluate, such information to determine Enrollee’s continuing enrollment in the Contractor’s Service Area under Covered California’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 Covered California in the event that it becomes aware that such representation may not be accurate.