Termination for Discontinuance of a Product or all Products within a Market. Health Plan may terminate a particular product or all products offered in a small or large group market as permitted or required by law. If Health Plan discontinues offering a particular grandfathered product in a market, Health Plan may terminate this Agreement with respect to that product upon 90 days prior written notice to Group. Health Plan will offer Group another product that it makes available to groups in the small or large group market, as applicable. If Health Plan discontinues offering all products to groups in a small or large group market, as applicable, Health Plan may terminate this Agreement upon 180 days prior written notice to Group and Health Plan will not offer any other product to Group. A "product" is a combination of benefits and services that is defined by a distinct Evidence of Coverage. Health Plan may terminate a particular product or all products offered in the group market as permitted or required by law. If Health Plan discontinues offering a particular product (other than a grandfathered product) in the group market, Health Plan may terminate this Agreement with respect to that product upon 90 days prior written notice to Group. Health Plan will offer Group another product that it makes available the group market. If Health Plan discontinues offering all products in the group market, Health Plan may terminate this Agreement upon 180 days prior written notice to Group and Health Plan will not offer any other product to Group. A "product" is a combination of benefits and services that is defined by a distinct Evidence of Coverage. Contribution and Participation Requirements No change in Group's contribution or participation requirements listed below is effective for purposes of this Agreement unless Health Plan consents in writing. As a condition to consenting to Group's revised contribution and participation requirements, Health Plan may require Group to agree to amend the Premiums, benefits, or other provisions of this Agreement. Group must: • Contribute to all health care coverage available through Group on a basis that does not financially discriminate against Health Plan or against people who choose to enroll in Health Plan • For each Family, Group's contribution must be no less than 50 percent of the Premiums required for the lowest-priced Xxxxxx Permanente medical plan offered by your Group • Ensure that: all employees enrolled in Health Plan must meet the definition of "eligible employee" in Section 1357.500 or 1357.600 all employees enrolled in Health Plan are covered by workers' compensation or the employer's liability benefits, unless not required by law to be covered at least 70 percent of eligible employees are covered by a group health care plan at least one active employee is enrolled under this Agreement all Subscribers live or work inside the Service Area applicable to their coverage when they enroll • Meet all applicable legal and contractual requirements, such as: meet and continue to meet the definition of "small employer" or "guaranteed association" in Section 1357.500 or 1357.600 of the California Health and Safety Code for Groups enrolled as guaranteed associations, meet and continue to meet all legal requirements applicable to guaranteed associations elect any coverage that Group is required by law to provide distribute disclosures about coverage as described under "Member Information" in the "Miscellaneous Provisions" section adhere to all requirements set forth in the applicable Evidence of Coverage obtain Health Plan's prior written approval of any Group eligibility requirements that are not stated in the applicable use Member enrollment application forms that are provided or approved by Health Plan offer enrollment in accord with eligibility requirements in state law (for example, domestic partners must be eligible if married spouses are eligible and disabled dependents must be eligible if dependent children are eligible) • Offer enrollment in Health Plan to all eligible people on conditions no less favorable than those for any other health care plan available through Group • Meet the Health Plan offering requirement to not fund or directly reimburse Members for any Deductibles, Coinsurance, or Copayments, including employer reimbursements of employee Cost Sharing through employee flexible spending accounts (FSAs) or limited purpose FSAs, except for the following: Group must fund a health reimbursement account (HRA) in accord with federal tax law if the employee is enrolled in a Deductible HMO with HRA Plan Group may fund a health savings account (HSA) in accord with federal tax law if the employee is enrolled in a HSA- Qualified Deductible HMO Plan • Upon request, provide Health Plan with documentation that proves each Subscriber is an eligible employee, proprietor, or partner. Also, Group must provide, upon request, documentation that demonstrates to Health Plan's satisfaction that Group is complying with all contribution and participation requirements Miscellaneous Provisions Assignment Health Plan may assign this Agreement. Group may not assign this Agreement or any of the rights, interests, claims for money due, benefits, or obligations hereunder without Health Plan's prior written consent. This Agreement shall be binding on the successors and permitted assignees of Health Plan and Group.
Appears in 2 contracts
Samples: Group Subscriber Agreement, Group Subscriber Agreement
Termination for Discontinuance of a Product or all Products within a Market. Health Plan may terminate a particular product or all products offered in a small or large group market as permitted or required by law. If Health Plan discontinues offering a particular grandfathered product in a market, Health Plan may terminate this Agreement with respect to that product upon 90 days prior written notice to Group. Health Plan will offer Group another product that it makes available to groups in the small or large group market, as applicable. If Health Plan discontinues offering all products to groups in a small or large group market, as applicable, Health Plan may terminate this Agreement upon 180 days prior written notice to Group and Health Plan will not offer any other product to Group. A "product" is a combination of benefits and services that is defined by a distinct Evidence of Coverage. Health Plan may terminate a particular product or all products offered in the group market as permitted or required by law. If Health Plan discontinues offering a particular product (other than a grandfathered product) in the group market, Health Plan may terminate this Agreement with respect to that product upon 90 days prior written notice to Group. Health Plan will offer Group another product that it makes available the group market. If Health Plan discontinues offering all products in the group market, Health Plan may terminate this Agreement upon 180 days prior written notice to Group and Health Plan will not offer any other product to Group. A "product" is a combination of benefits and services that is defined by a distinct Evidence of Coverage. Contribution and Participation Requirements No change in Group's contribution or participation requirements listed below is effective for purposes of this Agreement unless Health Plan consents in writing. As a condition to consenting to Group's revised contribution and participation requirements, Health Plan may require Group to agree to amend the Premiums, benefits, or other provisions of this Agreement. Group must: • Contribute to all health care coverage available through Group on a basis that does not financially discriminate against Health Plan or against people who choose to enroll in Health Plan • For each Family, Group's contribution must be no less than 50 percent of the Premiums required for the lowest-priced Xxxxxx Permanente medical plan offered by your Group • Ensure that: ♦ all employees enrolled in Health Plan must meet the definition of "eligible employee" in Section 1357.500 or 1357.600 ♦ all employees enrolled in Health Plan are covered by workers' compensation or the employer's liability benefits, unless not required by law to be covered ♦ at least 70 percent of eligible employees are covered by a group health care plan ♦ at least one active employee is enrolled under this Agreement ♦ all Subscribers live or work inside the Service Area applicable to their coverage when they enroll • Meet all applicable legal and contractual requirements, such as: ♦ meet and continue to meet the definition of "small employer" or "guaranteed association" in Section 1357.500 or 1357.600 of the California Health and Safety Code ♦ for Groups enrolled as guaranteed associations, meet and continue to meet all legal requirements applicable to guaranteed associations ♦ elect any coverage that Group is required by law to provide ♦ distribute disclosures about coverage as described under "Member Information" in the "Miscellaneous Provisions" section ♦ adhere to all requirements set forth in the applicable Evidence of Coverage ♦ obtain Health Plan's prior written approval of any Group eligibility requirements that are not stated in the applicable ♦ use Member enrollment application forms that are provided or approved by Health Plan ♦ offer enrollment in accord with eligibility requirements in state law (for example, domestic partners must be eligible if married spouses are eligible and disabled dependents must be eligible if dependent children are eligible) • Offer enrollment in Health Plan to all eligible people on conditions no less favorable than those for any other health care plan available through Group • Meet the Health Plan offering requirement to not fund or directly reimburse Members for any Deductibles, Coinsurance, or Copayments, including employer reimbursements of employee Cost Sharing through employee flexible spending accounts (FSAs) or limited purpose FSAs, except for the following: ♦ Group must fund a health reimbursement account (HRA) in accord with federal tax law if the employee is enrolled in a Deductible HMO with HRA Plan ♦ Group may fund a health savings account (HSA) in accord with federal tax law if the employee is enrolled in a HSA- Qualified Deductible HMO Plan • Upon request, provide Health Plan with documentation that proves each Subscriber is an eligible employee, proprietor, or partner. Also, Group must provide, upon request, documentation that demonstrates to Health Plan's satisfaction that Group is complying with all contribution and participation requirements Miscellaneous Provisions Assignment Health Plan may assign this Agreement. Group may not assign this Agreement or any of the rights, interests, claims for money due, benefits, or obligations hereunder without Health Plan's prior written consent. This Agreement shall be binding on the successors and permitted assignees of Health Plan and Group.
Appears in 1 contract
Samples: Group Subscriber Agreement
Termination for Discontinuance of a Product or all Products within a Market. Health Plan may terminate a particular product or all products offered in a small or large group market as permitted or required by law. If Health Plan discontinues offering a particular grandfathered product in a market, Health Plan may terminate this Agreement with respect to that product upon 90 days prior written notice to Group. Health Plan will offer Group another product that it makes available to groups in the small or large group market, as applicable. If Health Plan discontinues offering all products to groups in a small or large group market, as applicable, Health Plan may terminate this Agreement upon 180 days prior written notice to Group and Health Plan will not offer any other product to Group. A "“product" ” is a combination of benefits and services that is defined by a distinct Evidence of Coverage. Health Plan may terminate a particular product or all products offered in the group market as permitted or required by law. If Health Plan discontinues offering a particular product (other than a grandfathered product) in the group market, Health Plan may terminate this Agreement with respect to that product upon 90 days prior written notice to Group. Health Plan will offer Group another product that it makes available in the group market. If Health Plan discontinues offering all products in the group market, Health Plan may terminate this Agreement upon 180 days prior written notice to Group and Health Plan will not offer any other product to Group. A "“product" ” is a combination of benefits and services that is defined by a distinct Evidence of Coverage. Contribution and Participation Requirements No change in Group's ’s contribution or participation requirements listed below is effective for purposes of this Agreement unless Health Plan consents in writing. As a condition to consenting to Group's ’s revised contribution and participation requirements, Health Plan may require Group to agree to amend the Premiums, benefits, or other provisions of this Agreement. Group must: • Contribute to all health care coverage available through Group on a basis that does not financially discriminate against Health Plan or against people who choose to enroll in Health Plan • For each Family, Group's contribution must be no less than 50 percent of the Premiums required for the lowest-priced Xxxxxx Permanente medical plan offered by your Group • Ensure that: all employees enrolled in Health Plan must meet the definition of "eligible employee" in Section 1357.500 or 1357.600 all employees enrolled in Health Plan are covered by workers' compensation or the employer's liability benefits, unless not required by law to be covered at least 70 percent of eligible employees are covered by a group health care plan at least one active employee is enrolled under this Agreement ♦ all Subscribers live or work inside the Service Area applicable to their coverage when they enroll (except that Group must ensure that Subscribers live inside the Service Area applicable to their coverage when they enroll if Group chooses not to have a “live or work” eligibility rule, and that Xxxxxx Permanente Senior Advantage Members live inside the Service Area applicable to their coverage when they enroll in Senior Advantage and thereafter) ♦ at least one employee, proprietor, or partner who lives or works inside the Service Area is eligible to enroll as a Subscriber • Meet all applicable legal and contractual requirements, such as: meet and continue to meet the definition of "small employer" or "guaranteed association" in Section 1357.500 or 1357.600 of the California Health and Safety Code for Groups enrolled as guaranteed associations, meet and continue to ♦ meet all legal requirements applicable to guaranteed associations elect any coverage that Group is required by law to provide distribute disclosures about coverage as described under "Member Information" in the "Miscellaneous Provisions" section adhere to all Health Plan requirements set forth in the applicable Evidence “Rate Assumptions and Requirements” section of Coverage obtain Health Plan's prior written approval of any Group eligibility requirements that are not stated in the applicable use Member enrollment application forms that are provided or approved by Rate Proposal document (Group’s Health Plan account manager can provide Group with a copy of the Rate Proposal if Group does not have one) ♦ offer enrollment in accord with eligibility requirements in state law (for example, domestic partners must be eligible if married spouses are eligible and disabled dependents must be eligible if dependent children are eligible) • Offer enrollment in Health Plan to all eligible people on conditions no less favorable than those for any other health care plan available through Group • Meet the Health Plan offering requirement to not fund or directly reimburse Members for any Deductibles, Coinsurance, or Copayments, including employer reimbursements of employee Cost Sharing through employee flexible spending accounts (FSAs) or limited purpose FSAs, except for the following: Group must fund a health reimbursement account (HRA) in accord with federal tax law if the employee is enrolled in a Deductible HMO with HRA Plan Group may fund a health savings account (HSA) in accord with federal tax law if the employee is enrolled in a HSA- Qualified Deductible HMO Plan • Upon request, provide Health Plan with documentation that proves each Subscriber is an eligible employee, proprietor, or partner. Also, Group must provide, upon request, documentation that demonstrates to Health Plan's satisfaction that Group is complying with all contribution and participation requirements Miscellaneous Provisions Assignment Health Plan may assign this Agreement. Group may not assign this Agreement or any of the rights, interests, claims for money due, benefits, or obligations hereunder without Health Plan's prior written consent. This Agreement shall be binding on the successors and permitted assignees of Health Plan and Group.
Appears in 1 contract
Samples: Group Agreement
Termination for Discontinuance of a Product or all Products within a Market. Health Plan may terminate a particular product product, or all products offered in a small or large group market as permitted or required by law. If Health Plan discontinues offering a particular grandfathered product in a market, Health Plan may terminate this Agreement with respect to that product upon 90 days prior written notice to Group. Health Plan will offer Group another product that it makes available to groups in the small or large group market, as applicable. If Health Plan discontinues offering all products to groups in a small or large group market, as applicable, Health Plan may terminate this Agreement upon 180 days prior written notice to Group and Health Plan will not offer any other product to Group. A "product" is a combination of benefits and services that is defined by a distinct Evidence of Coverage. Health Plan may terminate a particular product or all products offered in the group market as permitted or required by law. If Health Plan discontinues offering a particular product (other than a grandfathered product) in the group market, Health Plan may terminate this Agreement with respect to that product upon 90 days prior written notice to Group. Health Plan will offer Group another product that it makes available the group market. If Health Plan discontinues offering all products in the group market, Health Plan may terminate this Agreement upon 180 days prior written notice to Group and Health Plan will not offer any other product to Group. A "product" is a combination of benefits and services that is defined by a distinct Evidence of Coverage. Contribution and Participation Requirements No change in Group's contribution or participation requirements listed below is effective for purposes of this Agreement unless Health Plan consents in writing. As a condition to consenting to Group's revised contribution and participation requirements, Health Plan may require Group to agree to amend the Premiums, benefits, or other provisions of this Agreement. Group must: • Contribute to all health care coverage available through Group on a basis that does not financially discriminate against Health Plan or against people who choose to enroll in Health Plan • For each Family, Group's contribution must be no less than an amount that is at least 50 percent of the Premiums required for a single Subscriber for the lowest-priced Xxxxxx Permanente medical plan offered by your Group coverage in which the Subscriber is enrolled • Ensure that: ♦ all employees enrolled in Health Plan must meet the definition of "eligible employee" work at least 20 hours per week unless Health Plan agrees otherwise in Section 1357.500 or 1357.600 writing ♦ all employees enrolled in Health Plan are covered by workers' compensation or the employer's liability benefits, unless not required by law to be covered ♦ at least 70 75 percent of eligible employees are covered by a group health care plan at least one active employee is enrolled under this Agreement ♦ all Subscribers that enroll in Xxxxxx Permanente Medicare Advantage must live or work inside the Service Area applicable to their coverage. ♦ at least one employee, proprietor, or partner who lives or works inside the Service Area is eligible to enroll as a Subscriber ♦ the number of Subscribers enrolled under this Agreement does not fall below the greater of five employees or five percent of the total number of eligible employees ♦ the ratio between the number of Subscribers and the total number of people who are eligible to enroll as Subscribers will not drop by 20 percent or more. For the purpose of computing this percentage requirement, Group may include subscribers and those eligible to enroll as subscribers under all other agreements between Group and Health Plan and all other Regions • Hold an annual open enrollment period during which all eligible people may enroll in Health Plan. Also, Group must not hold open enrollment for 2024 until Group receives its 2024 group agreement Premium and coverage information from Health Plan. If Group holds the open enrollment without receiving 2024 group agreement Premium and coverage information, Health Plan may change Premiums and coverage (including benefits and Cost Sharing) when they enroll it offers to renew Group's Agreement as described under "Renewal" in the "Term of Agreement and Renewal" section • Meet all applicable legal and contractual requirements, such as: meet and continue ♦ distribution of Evidence of Coverage provided by Health Plan to meet Subscribers in accord with applicable laws, including the definition of "small employer" or "guaranteed association" in Section 1357.500 or 1357.600 Medicare-as-Secondary-Payer laws distribution of the California CMS required pre-enrollment materials, which are available upon request from Health and Safety Code for Groups enrolled as guaranteed associationsPlan, meet and continue prior to meet all legal requirements applicable to guaranteed associations elect any coverage that Group is required by law to provide distribute disclosures about coverage as described under "Member Information" in the "Miscellaneous Provisions" section enrollment ♦ adhere to all requirements set forth in the applicable Evidence of Coverage ♦ obtain Health Plan's prior written approval of any Group eligibility requirements that are not stated in the applicable Evidence of Coverage ♦ use Member enrollment application forms that are provided or approved by Health Plan offer as described under "Enrollment Application Requirements" in the "Miscellaneous Provisions" section ♦ comply with CMS requirements governing enrollment in, and disenrollment from, Xxxxxx Permanente Medicare Advantage • Meet all Health Plan requirements set forth in accord with eligibility requirements in state law (for example, domestic partners must be eligible if married spouses are eligible the "Rate Assumptions and disabled dependents must be eligible if dependent children are eligible) Requirements" section of the Rate Proposal document • Offer enrollment in Health Plan to all eligible people on conditions no less favorable than those for any other health care plan available through Group • Meet the Permit Health Plan offering requirement to not fund or directly reimburse Members for any Deductibles, Coinsurance, or Copayments, including employer reimbursements of employee Cost Sharing through employee flexible spending accounts (FSAs) or limited purpose FSAs, except for the following: Group must fund a health reimbursement account (HRA) in accord examine Group's records with federal tax law if the employee is enrolled in a Deductible HMO with HRA Plan Group may fund a health savings account (HSA) in accord with federal tax law if the employee is enrolled in a HSA- Qualified Deductible HMO Plan • Upon request, provide Health Plan with documentation that proves each Subscriber is an eligible employee, proprietor, or partner. Also, Group must provide, upon request, documentation that demonstrates respect to Health Plan's satisfaction that Group is complying with all contribution and participation requirements requirements, eligibility, and payments under this Agreement Miscellaneous Provisions Assignment Health Plan may assign this Agreement. Group may not assign this Agreement or any of the rights, interests, claims for money due, benefits, or obligations hereunder without Health Plan's prior written consent. This Agreement shall be binding on the successors and permitted assignees of Health Plan and Group.
Appears in 1 contract
Samples: Group Agreement
Termination for Discontinuance of a Product or all Products within a Market. Health Plan may terminate a particular product or all products offered in a small or large group market as permitted or required by law. If Health Plan discontinues offering a particular grandfathered product in a market, Health Plan may terminate this Agreement with respect to that product upon 90 days prior written notice to Group. Health Plan will offer Group another product that it makes available to groups in the small or large group market, as applicable. If Health Plan discontinues offering all products to groups in a small or large group market, as applicable, Health Plan may terminate this Agreement upon 180 days prior written notice to Group and Health Plan will not offer any other product to Group. A "product" is a combination of benefits and services that is defined by a distinct Evidence of Coverage. Health Plan may terminate a particular product or all products offered in the group market as permitted or required by law. If Health Plan discontinues offering a particular product (other than a grandfathered product) in the group market, Health Plan may terminate this Agreement with respect to that product upon 90 days prior written notice to Group. Health Plan will offer Group another product that it makes available the group market. If Health Plan discontinues offering all products in the group market, Health Plan may terminate this Agreement upon 180 days prior written notice to Group and Health Plan will not offer any other product to Group. A "product" is a combination of benefits and services that is defined by a distinct Evidence of Coverage. Contribution and Participation Requirements No change in Group's contribution or participation requirements listed below is effective for purposes of this Agreement unless Health Plan consents in writing. As a condition to consenting to Group's revised contribution and participation requirements, Health Plan may require Group to agree to amend the Premiums, benefits, or other provisions of this Agreement. Group must: • Contribute to all health care coverage available through Group on a basis that does not financially discriminate against Health Plan or against people who choose to enroll in Health Plan • For each Family, Group's contribution must be no less than 50 percent of the Premiums required for the lowest-priced Xxxxxx Permanente medical plan offered by your Group • Ensure that: all employees enrolled in Health Plan must meet the definition of "eligible employee" in Section 1357.500 or 1357.600 all employees enrolled in Health Plan are covered by workers' compensation or the employer's liability benefits, unless not required by law to be covered at least 70 percent of eligible employees are covered by a group health care plan at least one active employee is enrolled under this Agreement ♦ all Subscribers live or work inside the Service Area applicable to their coverage when they enroll (except that Group must ensure that Subscribers live inside the Service Area applicable to their coverage when they enroll if Group chooses not to have a "live or work" eligibility rule, and that Xxxxxx Permanente Senior Advantage Members live inside the Service Area applicable to their coverage when they enroll in Senior Advantage and thereafter) ♦ at least one employee, proprietor, or partner who lives or works inside the Service Area is eligible to enroll as a Subscriber • Meet all applicable legal and contractual requirements, such as: meet and continue to meet the definition of "small employer" or "guaranteed association" in Section 1357.500 or 1357.600 of the California Health and Safety Code for Groups enrolled as guaranteed associations, meet and continue to ♦ meet all legal requirements applicable to guaranteed associations elect any coverage that Group is required by law to provide distribute disclosures about coverage as described under "Member Information" in the "Miscellaneous Provisions" section adhere to all Health Plan requirements set forth in the applicable Evidence "Rate Assumptions and Requirements" section of Coverage obtain Health Planthe Rate Proposal document (Group's prior written approval of any Group eligibility requirements that are not stated in the applicable use Member enrollment application forms that are provided or approved by Health Plan account manager can provide Group with a copy of the Rate Proposal if Group does not have one) ♦ offer enrollment in accord with eligibility requirements in state law (for example, domestic partners must be eligible if married spouses are eligible and disabled dependents must be eligible if dependent children are eligible) • Offer enrollment in Health Plan to all eligible people on conditions no less favorable than those for any other health care plan available through Group • Meet the Health Plan offering requirement to not fund or directly reimburse Members for any Deductibles, Coinsurance, or Copayments, including employer reimbursements of employee Cost Sharing through employee flexible spending accounts (FSAs) or limited purpose FSAs, except for the following: Group must fund a health reimbursement account (HRA) in accord with federal tax law if the employee is enrolled in a Deductible HMO with HRA Plan Group may fund a health savings account (HSA) in accord with federal tax law if the employee is enrolled in a HSA- Qualified Deductible HMO Plan • Upon request, provide Health Plan with documentation that proves each Subscriber is an eligible employee, proprietor, or partner. Also, Group must provide, upon request, documentation that demonstrates to Health Plan's satisfaction that Group is complying with all contribution and participation requirements Miscellaneous Provisions Assignment Health Plan may assign this Agreement. Group may not assign this Agreement or any of the rights, interests, claims for money due, benefits, or obligations hereunder without Health Plan's prior written consent. This Agreement shall be binding on the successors and permitted assignees of Health Plan and Group.
Appears in 1 contract
Samples: Group Agreement
