Common use of SHOP Clause in Contracts

SHOP. In the event that Contractor continues to offer small group coverage in the State following the Notice of Non-Recertification Election, Contractor shall comply with applicable laws, rules and regulations relating to the discontinuation of a benefit package, including those set forth at Section 1365 of the Health and Safety Code and Section 10713 of the Insurance Code. The termination of the Agreement shall occur upon the termination of coverage which shall be determined as follows: (i) In the event that an Employer’s plan year, as determined in accordance with 45 C.F.R. § 155.725, expires between the July 1 effective date of the Non-Recertification Election and the expiration of the Contract Year on December 31, Contractor shall provide coverage to Employers and Employees until the termination of the Agreement that shall be effective upon the expiration of the Employer’s first plan year that commences after the Non-Recertification Election. (ii) In the event that an Employer’s plan year terminates between January 1 and the July 1 effective date of the Notice of Non-Recertification, Contractor shall provide coverage until the termination of the Agreement effective upon the expiration of Employer’s first plan year that commences prior to the July 1 effective date of the Notice of Non-Recertification. (iii) In the event that an Employer’s plan year expires more than ninety (90) days following the Notice of Non-Recertification Election, the Exchange shall notify Employers and Employees in a format approved by the Exchange that Contractor’s QHP will not be available upon the next renewal anniversary date. (iv) Contractor shall comply with other requirements of the Exchange relating to the continuation and transition of coverage following Contractor’s Non-Recertification Election, including, without limitation, those relating to protocols and timing for the removal of Contractor from the listing of Certified QHPs to be selected by Employers and Employees, the commencement of coverage for new Employers and Employees, and termination and transition of coverage.

SHOP. In the event that Contractor continues to offer small group coverage in the State following the Notice of Non-Recertification Election, Contractor shall comply with applicable laws, rules and regulations relating to the discontinuation of a benefit package, including those set forth at Section 1365 of the Health and Safety Code and Section 10713 of the Insurance Code. The termination of the Agreement shall occur upon the termination of coverage which shall be determined as follows: (i) In the event that an Employer’s plan year, as determined in accordance with 45 C.F.R. § 155.725, expires between the July 1 effective date of the Non-Non- Recertification Election and the expiration of the Contract Year on December 31, Contractor shall provide coverage to Employers and Employees until the termination of the Agreement that shall be effective upon the expiration of the Employer’s first plan year that commences after the Non-Recertification Election. (ii) In the event that an Employer’s plan year terminates between January 1 and the July 1 effective date of the Notice of Non-Recertification, Contractor shall provide coverage until the termination of the Agreement effective upon the expiration of Employer’s first plan year that commences prior to the July 1 effective date of the Notice of Non-Recertification. (iii) In the event that an Employer’s plan year expires more than ninety (90) days following the Notice of Non-Recertification Election, the Exchange shall notify Employers and Employees in a format approved by the Exchange that Contractor’s QHP will not be available upon the next renewal anniversary date. (iv) Contractor shall comply with other requirements of the Exchange relating to the continuation and transition of coverage following Contractor’s Non-Recertification Election, including, without limitation, those relating to protocols and timing for the removal of Contractor from the listing of Certified QHPs to be selected by Employers and Employees, the commencement of coverage for new Employers and Employees, and termination and transition of coverage.

SHOP. In the event that Contractor continues to offer small group coverage in the State following the Notice of Non-Recertification Election, Contractor shall comply with applicable laws, rules and regulations relating to the discontinuation of a benefit package, including those set forth at Section 1365 1357.11 of the Health and Safety Code and Section 10713 of the Insurance Code. The termination of the Agreement shall occur upon the termination of coverage which shall be determined as follows: (i) In the event that an Employer’s plan year, as determined in accordance with 45 C.F.R. § 155.725, expires between the July 1 effective date of the Non-Recertification Election and the expiration of the Contract Year on December 31, Contractor shall provide coverage to Employers and Employees until the termination of the Agreement that shall be effective upon the expiration of the Employer’s first plan year that commences after the Non-Recertification Election. (ii) In the event that an Employer’s plan year terminates between January 1 and the July 1 effective date of the Notice of Non-Recertification, Contractor shall provide coverage until the termination of the Agreement effective upon the expiration of Employer’s first plan year that commences prior to the July 1 effective date of the Notice of Non-Recertification. (iii) In the event that an Employer’s plan year expires more than ninety (90) days following the Notice of Non-Recertification Election, the Exchange shall notify Employers and Employees in a format approved by the Exchange that Contractor’s QHP will not be available upon the next renewal anniversary date. (iv) Contractor shall comply with other requirements of the Exchange relating to the continuation and transition of coverage following Contractor’s Non-Recertification Election, including, without limitation, those relating to protocols and timing for the removal of Contractor from the listing of Certified QHPs to be selected by Employers and Employees, the commencement of coverage for new Employers and Employees, and termination and transition of coverage.

SHOP. In the event that Contractor continues to offer small group coverage in the State following the Notice of Non-Recertification Election, Contractor shall comply with applicable laws, rules and regulations relating to the discontinuation of a benefit package, including those set forth at Section 1365 of the Health and Safety Code and Section 10713 of the Insurance Code. The termination of the Agreement shall occur upon the termination of coverage which shall be determined as follows: (i) In the event that an Employer’s plan year, as determined in accordance with 45 C.F.R. § 155.725, expires between the July 1 effective date of the Non-Recertification Election and the expiration of the Contract Year on December 31, Contractor shall provide coverage to Employers and Employees until the termination of the Agreement that shall be effective upon the expiration of the Employer’s first plan year that commences after the Non-Recertification Election. (ii) In the event that an Employer’s plan year terminates between January 1 and the July 1 effective date of the Notice of Non-Recertification, Contractor shall provide coverage until the termination of the Agreement effective upon the expiration of Employer’s first plan year that commences prior to the July 1 effective date of the Notice of Non-Recertification.. Covered California – Final Health Plan Contract – May 202117, 2013 33 (iii) In the event that an Employer’s plan year expires more than ninety (90) days following the Notice of Non-Recertification Election, the Exchange shall notify Employers and Employees in a format approved by the Exchange that Contractor’s QHP will not be available upon the next renewal anniversary date. (iv) Contractor shall comply with other requirements of the Exchange relating to the continuation and transition of coverage following Contractor’s Non-Recertification Election, including, without limitation, those relating to protocols and timing for the removal of Contractor from the listing of Certified QHPs to be selected by Employers and Employees, the commencement of coverage for new Employers and Employees, and termination and transition of coverage.