Transitions of Coverage. To further Covered California’s mission of ensuring that as many individuals possible have the benefit of insurance coverage, Contractor agrees to establish policies and practices in coordination with Covered California that maximize smooth transitions and facilitate coverage for Enrollees to and from Covered California and other health coverage programs, including between Medi-Cal, Medicare, and other governmental health care programs, coverage provided by Employers, and for individuals with off-exchange coverage who may now or in the future benefit from Advanced Premium Tax Credits. With regard to facilitating the enrollment of consumers leaving employer sponsored coverage (ESI), Contractor shall coordinate with Covered California to make best efforts to ensure all consumers leaving ESI, including those who may be eligible for coverage required by the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”) and the California Continuation Benefits Replacement Act, Health and Safety Code § 1366.20 et seq. (“Cal-COBRA”), understand the options they may have for coverage through Covered California. Covered California expects Contractor to fully assist enrollee transition to other eligible coverage either in Medi-Cal or Covered California, as applicable and permitted by such programs. Covered California will assist enrollee transition from Covered California to coverage through Medi-Cal, Medicare or Employer Sponsored Insurance (ESI). To the extent Contractor has enrollees in small and large group ESI or Medi-Cal, to further the parties’ commitment to maximizing enrollment in health insurance coverage, Contractor will work with Covered California to develop and implement operational processes to ensure continuity of coverage for Enrollees transitioning from Contractor’s non-exchange lines of businesses to Covered California. This includes conducting consumer outreach efforts and supporting Covered California in the implementation of auto-enrollment or facilitated enrollment activities. Contractor shall conduct Consumer outreach to include an annual notification to Enrollees in Contractor’s individual and group health care coverage regarding their potential eligibility for reduced or no-cost coverage through Covered California and Medi-Cal as required by Health and Safety Code § 1366.50 and California Insurance Code §10786, and as further required by those statutes, shall provide Enrollee contact data for Covered California’s outreach to consumers who...
Transitions of Coverage. To further Covered California’s mission of ensuring that as many individuals possible have the benefit of insurance coverage, Contractor agrees to establish policies and practices in coordination with Covered California that maximize smooth transitions and facilitate coverage for Enrollees to and from Covered California and other health coverage programs, including between Medi-Cal, Medicare, and other governmental health care programs, coverage provided by Employers, including those who may be eligible for coverage required by the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”) and the California Continuation Benefits Replacement Act, Health and Safety Code § § 1366.20 et seq. (“Cal COBRA”), understand the options they may have for coverage through Covered California. Covered California expects Contractor to fully assist enrollee transition to other eligible coverage either in Medi-Cal or Covered California, as applicable. Covered California will assist enrollee transition from Covered California to coverage through Medi-Cal, Medicare or ESI.
