Common use of Terminations of Coverage Clause in Contracts

Terminations of Coverage. Contractor 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 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 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 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 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 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 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.

Terminations of Coverage. Contractor 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 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 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.