Common use of Terminations of Coverage Clause in Contracts

Terminations of Coverage. Contractor shall terminate an Enrollee’s coverage in a Contractor’s QDP 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 report information to Covered California regarding delinquent full or partial payments of premium owing by Qualified Individuals in such format and intervals as is reasonably requested by Covered California. Contractor shall notify the Agent or Agency of Record a late payment notification at the same time the Enrollee receives notification. Covered California and Contractor must send a termination transaction to the other party within ten (10) business days of any individual Enrollee termination. Contractor shall request termination of an enrollee for fraud or misrepresentation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Data Home, Contractor’s folder, 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.

Terminations of Coverage. Contractor shall terminate an Enrollee’s coverage in a Contractor’s QDP 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 report information to Covered California regarding delinquent full or partial payments of premium owing by Qualified Individuals in such format and intervals as is reasonably requested by Covered California. 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 the other party within ten (10) business days of any individual Covered California Enrollee termination. Contractor shall request termination of an enrollee a Covered California Enrollee for fraud or misrepresentation through the Carrier Referral Process (posted on the Contractor’s extranet website provided by Covered California (Data HomeHub page, Contractor’s foldersubsite, Data Integrity 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.