Common use of Transitions of Coverage Clause in Contracts

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 terminated from ESI coverage and are not known to have transitioned to other health coverage. Contractor shall make best efforts to assist Enrollees with transitioning to and from other programs, including prominently displaying information in termination of coverage material, on Contractor’s website, and by educating Service Center representatives on eligibility and enrollment considerations. Contractor shall work with Covered California and support implementation processes to assist Enrollees that may be eligible for auto-enrollment in Covered California coverage, including notification on coverage options or Enrollee’s right to opt-out of coverage. Contractor shall work with Covered California on content development to ensure Consumers receive consistent messaging and experience. Contractor shall ensure that effectuation only occurs either after binder payment is received or Enrollee opts-in to coverage.

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 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 terminated from ESI coverage and are not known to have transitioned to other health coverage. Contractor shall make best efforts to assist Enrollees with transitioning to and from other programs, including prominently displaying information in termination of coverage material, on Contractor’s website, and by educating Service Center representatives on eligibility and enrollment considerations. Contractor shall work with Covered California and support implementation processes to assist Enrollees that may be eligible for auto-enrollment in Covered California coverage, including notification on coverage options or Enrollee’s right to opt-out of coverage. Contractor shall work with Covered California on content development to ensure Consumers receive consistent messaging and experience. Contractor shall ensure that effectuation only occurs either after binder payment is received or Enrollee opts-in to coverage.

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 Employersemployer-sponsored insurance (ESI), 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 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 terminated from ESI coverage and are not known to have transitioned to other health coverage. Contractor shall make best efforts to assist Enrollees with transitioning to and from other programs, including prominently displaying information in termination of coverage material, on Contractor’s website, and by educating Service Center representatives on eligibility and enrollment considerations. Contractor shall work with Covered California and support implementation processes to assist Enrollees that may be eligible for auto-enrollment in Covered California coverage, including notification on coverage options or Enrollee’s right to opt-out of coverage. Contractor shall work with Covered California on content development to ensure Consumers consumers receive consistent messaging and experience. Contractor shall ensure that effectuation only occurs either after binder payment is received or Enrollee opts-in to coverage.

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 programsapplicable. 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 Californiabusinesses. 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 statutesrequired, shall provide Enrollee contact data for Covered California’s outreach to consumers who terminated from ESI coverage and are not known to have transitioned to other health coverage. Contractor shall make best efforts to assist Enrollees with transitioning to and from other programs, including prominently displaying information in termination of coverage material, on Contractor’s website, and by educating Service Center representatives on eligibility and enrollment considerations. Contractor shall work with Covered California and support implementation processes to assist Enrollees that may be eligible for auto-enrollment in Covered California coverage, including notification on coverage options or Enrollee’s right to opt-out of coverage. Contractor shall work with Covered California on content development to ensure Consumers receive consistent messaging and experience. Contractor shall ensure that effectuation only occurs either after binder payment is received or Enrollee opts-in to coverage.

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 programsapplicable. 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 terminated from ESI coverage and are not known to have transitioned to other health coverage. Contractor shall make best efforts to assist Enrollees with transitioning to and from other programs, including prominently displaying information in termination of coverage material, on Contractor’s website, and by educating Service Center representatives on eligibility and enrollment considerations. Contractor shall work with Covered California and support implementation processes to assist Enrollees that may be eligible for auto-enrollment in Covered California coverage, including notification on coverage options or Enrollee’s right to opt-out of coverage. Contractor shall work with Covered California on content development to ensure Consumers receive consistent messaging and experience. Contractor shall ensure that effectuation only occurs either after binder payment is received or Enrollee opts-in to coverage.

Transitions of Coverage. To further Covered California’s mission of ensuring that as many individuals as 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, and 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 employer sponsored coverage (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 Medicare, 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)applicable. To the extent Contractor has enrollees in small and large group ESI or Medi-CalESI, 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 terminated from ESI coverage and are not known to have transitioned to other health coverage. Contractor shall make best efforts to assist Enrollees with transitioning to and from other programs, including prominently displaying information in termination of coverage material, on Contractor’s website, and by educating Service Center representatives on eligibility and enrollment considerations. Contractor shall work with Covered California and support implementation processes to assist Enrollees that may be eligible for auto-enrollment in Covered California coverage, including notification on coverage options or Enrollee’s right to opt-out of coverage. Contractor shall work with Covered California on content development to ensure Consumers receive consistent messaging and experience. Contractor shall ensure that effectuation only occurs either after binder payment is received or Enrollee opts-in to coverage.

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 programsapplicable. 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 terminated from ESI coverage and are not known to have transitioned to other health coverage. Contractor shall make best efforts to assist Enrollees with transitioning to and from other programs, including prominently displaying information in termination of coverage material, on Contractor’s website, and by educating Service Center representatives on eligibility and enrollment considerations. Contractor shall work with Covered California and support implementation processes to assist Enrollees that may be eligible for auto-enrollment in Covered California coverage, including notification on coverage options or Enrollee’s right to opt-out of coverage. Contractor shall work with Covered California on content development to ensure Consumers receive consistent messaging and experience. Contractor shall ensure that effectuation only occurs either after binder payment is received or Enrollee opts-in to coverage.

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 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 terminated from ESI coverage and are not known to have transitioned to other health coverage. Contractor shall make best efforts to assist Enrollees with transitioning to and from other programs, including prominently displaying information in termination of coverage material, on Contractor’s website, and by educating Service Center representatives on eligibility and enrollment considerations. Contractor shall work with Covered California and support implementation processes to assist Enrollees that may be eligible for auto-enrollment in Covered California coverage, including notification on coverage options or Enrollee’s right to opt-out of coverage. Contractor shall work with Covered California on content development to ensure Consumers receive consistent messaging and experience. Contractor shall ensure that effectuation only occurs either after binder payment is received or Enrollee opts-in to coverage.

Transitions of Coverage. To further Covered California’s mission of ensuring that as many individuals as 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 offemployer-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 insurance (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 Medicare, 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 (a non-CCSB ESI). To the extent Contractor has enrollees in small and large group ESI or Medi-CalESI, 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 terminated from ESI coverage and are not known to have transitioned to other health coverage. Contractor shall make best efforts to assist Enrollees with transitioning to and from other programs, including prominently displaying information in termination of coverage material, on Contractor’s website, and by educating Service Center representatives on eligibility and enrollment considerations. Contractor shall work with Covered California and support implementation processes to assist Enrollees that may be eligible for auto-enrollment in Covered California coverage, including notification on coverage options or Enrollee’s right to opt-out of coverage. Contractor shall work with Covered California on content development to ensure Consumers receive consistent messaging and experience. Contractor shall ensure that effectuation only occurs either after binder payment is received or Enrollee opts-in to coverage.