Standard Benefit Designs. During the term of this Agreement, Contractor shall offer the QHPs identified in Attachment 1 and provide the benefits and services at the cost-sharing and actuarial cost levels described in the Benefit Plan Design summarized at Attachment 2 (“Benefit Plan Designs”), and as may be amended from time to time under applicable laws, rules and regulations or as otherwise authorized under this Agreement.
Standard Benefit Designs a) During the term of this Agreement, Contractor shall offer the QHPs identified in Attachment 1 and provide the benefits and services at the cost-sharing and actuarial cost levels described in the Covered California Patient-Centered Benefit Plan Designs as approved by the Board for the applicable Plan Year.
b) During the term of this Agreement, for any Plan Year that the cost of the cost-sharing reduction program is built into the premium for Contractor’s Silver-level QHPs, Contractor shall offer a non-mirrored Silver-level plan, that is not a QHP, outside of Covered California that complies with the benefits and services at the cost-sharing and actuarial cost level described in the plan design at Attachment 3 (“Silver 70 Off-Exchange Plan, Non-Mirrored Silver Plan Design”). This plan must not have any rate increase or cost attributable to the cost of the cost-sharing reduction program.
Standard Benefit Designs. During the term of this Agreement, Contractor shall offer the QHPs identified in Attachment 1 and provide the benefits and services at the cost-sharing and actuarial cost levels described in the Covered California Patient-Centered Benefit Plan Designs as approved by the Board for the applicable Plan Year. In addition to standardized benefit designs, Contractor may submit alternate benefit designs (ABD) for Contractor’s licensed geographic service area. Alternate benefit designs are optional. Alternate benefit designs must comply with state statutory and regulatory requirements. The alternate benefit design offering should incorporate the commission rate guidance utilized for all Covered California for Small Business plans.
Standard Benefit Designs a) During the term of this Agreement, Contractor shall offer the QHPs identified in Attachment 1 and provide the benefits and services at the cost-sharing and actuarial cost levels described in the Benefit Plan Design summarized at Attachment 2 (“Benefit Plan Designs”), and as may be amended from time to time under applicable laws, rules and regulations or as otherwise authorized under this Agreement.
b) During the term of this Agreement, for any plan year that the cost of the cost-sharing reduction program is built into the premium for Contractor’s Silver-level QHPs, Contractor shall offer a non-mirrored Silver-level plan, that is not a QHP, outside of Covered California that complies with the benefits and services at the cost-sharing and actuarial cost level described in the plan design at Attachment 3 (“Silver 70 Off-Exchange Plan, Non-Mirrored Silver Plan Design”). This plan must not have any rate increase or cost attributable to the cost of the cost-sharing reduction program.
