Terminations of Coverage. Contractor shall provide a Covered California Enrollee with notice and shall terminate coverage in a Contractor’s QHP in accordance with the requirements established by Covered California pursuant to 10 CCR § 6506 and other applicable State and Federal laws, rules, and regulations. Contractor shall terminate coverage for an individual Covered California Enrollee’s non-payment of premium as follows: (i) effective as of the last Day of the first month of a three (3) month grace period in the event of nonpayment of premiums by individuals receiving advance payments of the premium tax credit or State premium assistance payments; or (ii) effective the last Day of coverage established by grace periods under applicable State law, including requirements relating to Health and Safety Code § 1365 and Insurance Code § 10273.6 for individuals not receiving advance payments of the premium tax credit or State premium assistance. Contractor shall notify the Agent or Agency of Record of a late payment notification at the same time the Covered California Enrollee receives notification. Covered California must send a termination transaction to Contractor within ten (10) business days of any individual Covered California Enrollee termination. Contractor must send a termination transaction to Covered California within ten (10) Days of grace period expiration. Contractor shall request termination of a Covered California Enrollee for fraud or misrepresentation through the Carrier Referral Process posted on the Contractor’s extranet website provided by Covered California (Carrier Management (External) page, Contractor’s folder, Data Integrity, Fraud Referral folder) and provide Covered California with supporting documentation for each request to terminate. Contractor may not terminate for fraud or misrepresentation without prior approval from Covered California.
Appears in 6 contracts
Samples: Qualified Health Plan Issuer Contract, Qualified Health Plan Issuer Contract, Qualified Health Plan Issuer Contract
Terminations of Coverage. Contractor shall provide a Covered California Enrollee with notice and shall terminate coverage in a Contractor’s QHP in accordance with the requirements established by Covered California pursuant to 10 CCR § 6506 and other applicable State and Federal laws, rules, and regulations. Contractor shall terminate coverage for an individual Covered California Enrollee’s non-payment of premium as follows: (i) effective as of the last Day of the first month of a three (3) month grace period in the event of nonpayment of premiums by individuals receiving advance payments of the premium tax credit or State premium assistance payments; or (ii) effective the last Day of coverage established by grace periods under applicable State law, including requirements relating to Health and Safety Code § 1365 and Insurance Code § 10273.6 for individuals not receiving advance payments of the premium tax credit or State premium assistance. Contractor shall notify the Agent or Agency of Record of a late payment notification at the same time the Covered California Enrollee receives notification. Covered California and Contractor must send a termination transaction to Contractor the other partyContractor within ten (10) business days of any individual Covered California Enrollee termination. Contractor must send a termination transaction to Covered California within ten (10) Days of grace period expiration. Contractor shall request termination of a Covered California Enrollee for fraud or misrepresentation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Carrier Management (External) Hub page, Contractor’s foldersubsite, Data IntegrityIntegrity Files, Fraud Referral, Fraud Referral Rev. folder)) and provide Covered California with supporting documentation for each request to terminate. Contractor may not terminate for fraud or misrepresentation without prior approval from Covered California.
Appears in 2 contracts
Samples: Covered California Qualified Health Plan Issuer Contract, Qualified Health Plan Issuer Contract
Terminations of Coverage. Contractor shall provide a Covered California Enrollee with notice and shall terminate coverage in a Contractor’s QHP in accordance with the requirements established by Covered California pursuant to 10 CCR § 6506 and other applicable State and Federal laws, rules, and regulations. Contractor shall terminate coverage for an individual Covered California Enrollee’s non-payment of premium as follows: (i) effective as of the last Day of the first month of a three (3) month grace period in the event of nonpayment of premiums by individuals receiving advance payments of the premium tax credit or State premium assistance payments; or (ii) effective the last Day of coverage established by grace periods under applicable State law, including requirements relating to Health and Safety Code § 1365 and Insurance Code § 10273.6 for individuals not receiving advance payments of the premium tax credit or State premium assistance. Contractor shall notify the Agent or Agency of Record of a late payment notification at the same time the Covered California Enrollee receives notification. Covered California must send a termination transaction to Contractor within ten (10) business days of any individual Covered California Enrollee termination. Contractor must send a termination transaction to Covered California within ten (10) Days of grace period expiration. Contractor shall request termination of a Covered California Enrollee for fraud or misrepresentation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Carrier Management (External) Hub page, Contractor’s foldersubsite, Data IntegrityIntegrity Files, Fraud Referral, Fraud Referral Rev. folder)) and provide Covered California with supporting documentation for each request to terminate. Contractor may not terminate for fraud or misrepresentation without prior approval from Covered California.
Appears in 1 contract
Samples: Covered California Qualified Health Plan Issuer Contract
Terminations of Coverage. Contractor shall provide a Covered California Enrollee with notice and shall terminate coverage in a Contractor’s QHP in accordance with the requirements established by Covered California pursuant to 10 CCR § 6506 and other applicable State and Federal laws, rules, and regulations. Contractor shall terminate coverage for an individual Covered California Enrollee’s non-payment of premium as follows: (i) effective as of the last Day of the first month of a three (3) month grace period in the event of nonpayment of premiums by individuals receiving advance payments of the premium tax credit or State premium assistance payments; or (ii) effective the last Day of coverage established by grace periods under applicable State law, including requirements relating to Health and Safety Code § 1365 and Insurance Code § 10273.6 for individuals not receiving advance payments of the premium tax credit or State premium assistance. Contractor shall notify the Agent or Agency of Record of a late payment notification at the same time the Covered California Enrollee receives notification. Covered California and Contractor must send a termination transaction to Contractor the other party within ten (10) business days of any individual Covered California Enrollee termination. Contractor must send a termination transaction to Covered California within ten (10) Days of grace period expiration. Contractor shall request termination of a Covered California Enrollee for fraud or misrepresentation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Carrier Management (External) Hub page, Contractor’s foldersubsite, Data IntegrityIntegrity Files, Fraud Referral, Fraud Referral Rev. folder)) and provide Covered California with supporting documentation for each request to terminate. Contractor may not terminate for fraud or misrepresentation without prior approval from Covered California.
Appears in 1 contract
Terminations of Coverage. Contractor shall provide a Covered California Enrollee with notice and shall terminate coverage in a Contractor’s QHP in accordance with the requirements established by Covered California pursuant to 10 CCR § 6506 and other applicable State and Federal laws, rules, and regulations. Contractor shall terminate coverage for an individual Covered California Enrollee’s non-payment of premium as follows: (i) effective as of the last Day of the first month of a three (3) month grace period in the event of nonpayment of premiums by individuals receiving advance payments of the premium tax credit or State premium assistance payments; or (ii) effective the last Day of coverage established by grace periods under applicable State law, including requirements relating to Health and Safety Code § 1365 and Insurance Code § 10273.6 for individuals not receiving advance payments of the premium tax credit or State premium assistance. Contractor shall notify the Agent or Agency of Record of a late payment notification at the same time the Covered California Enrollee receives notification. Covered California must send a termination transaction to Contractor within ten (10) business days of any individual Covered California Enrollee termination. Contractor must send a termination transaction to Covered California within ten (10) Days of grace period expiration. Contractor shall request termination of a Covered California Enrollee for fraud or misrepresentation through the Carrier Referral Process posted on the Contractor’s extranet website provided by Covered California (Carrier Management (External) page, Contractor’s folder, Data Integrity, Fraud Referral folder) and provide Covered California with supporting documentation for each request to terminate. Contractor may not terminate for fraud or misrepresentation without prior approval from Covered California.
Appears in 1 contract
Samples: Covered California Qualified Health Plan Issuer Contract
Terminations of Coverage. Contractor shall provide a Covered California Enrollee with notice and shall terminate coverage in a Contractor’s QHP in accordance with the requirements established by Covered California pursuant to 10 CCR § 6506 and other applicable State and Federal laws, rules, and regulations. Contractor shall terminate coverage for an individual Covered California Enrollee’s non-payment of premium as follows: (i) effective as of the last day Day of the first month of a three (3) month grace period in the event of nonpayment of premiums by individuals receiving advance payments of the premium tax credit or State premium assistance payments; or (ii) effective the last day Day of coverage established by grace periods under applicable State law, including requirements relating to Health and Safety Code § 1365 and Insurance Code § 10273.6 for individuals not receiving advance payments of the premium tax credit or State premium assistance. Contractor shall notify the Agent or Agency of Record of a late payment notification at the same time the Covered California Enrollee receives notification. Covered California and Contractor must send a termination transaction to Contractor the other party within ten (10) business days of any individual Covered California Enrollee termination. Contractor must send a termination transaction to Covered California within ten (10) Days of grace period expiration. Contractor shall request termination of a an Covered California enrollee Enrollee for fraud or misrepresentation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Carrier Management (External) Hub page, Contractor’s subsite, Data Integrity Files, Fraud Referral, Fraud Referral Rev. folder)(Data Home, Contractor’s folder, Data Integrity, Fraud Referral folder)) and provide Covered California with supporting documentation for each request to terminate. Contractor may not terminate for fraud or misrepresentation without prior approval from Covered California.
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