Common use of Uniform Premium Requirements Clause in Contracts

Uniform Premium Requirements. With respect to the premiums charged to Members for Part C and/or Part D drug benefits, you may determine how much of a Member’s Part C and/or Part D monthly beneficiary premium you will subsidize, provided that: (i) if you subsidize different amounts for different classes of Members in a plan, such classes will be reasonable and based on objective business criteria, such as years of service, business location, job category and nature of compensation (for example, salaried and hourly), and different classes cannot be based on eligibility for the low-income subsidy; (ii) the premium will not vary for individuals within a given class of Members; and (iii) a Member cannot be charged more than the sum of their standard Part D beneficiary premium or the monthly beneficiary premium for basic benefits as defined in 42 CFR § 422.2 (i.e., all Medicare-covered benefits, except hospice services); and 100% of the monthly beneficiary premium for their non-Medicare Part C and/or Part D benefits (if any). You must pass through any direct subsidy payments received from CMS to reduce the amount the Member pays (or, in those instances when your employee pays premiums on behalf of their eligible spouse or covered dependent, the amount the employee pays). Low Income Subsidy (LIS). The low-income premium subsidy that CMS pays on behalf of an LIS-eligible Member must be passed through to the LIS-eligible Member. With respect to the premium contributions collected from your LIS-eligible Members, the monthly low-income premium subsidy will first be used to reduce that portion of the premium paid for by the LIS-eligible Member, with any remaining portion of the premium subsidy amount then used to reduce the employer’s premium contribution. You will be responsible for reducing up front the premium contribution amounts for your LIS-eligible Members. If you are not able to reduce an LIS-eligible Member’s premium contribution amount up front that has been previously paid by the LIS-eligible Member (or, your employee if they pay premiums on behalf of the LIS-eligible Member), you must directly refund the low-income premium subsidy amount up to the monthly premium contribution that you previously collected from the LIS-eligible Member (or, your employee, if applicable). You are required to refund the LIS-eligible Member (or, your employee, if applicable) within 45 days of the date Blue Cross and Blue Shield receives the low-income premium subsidy amount payment from CMS on behalf of your LIS-eligible Members.

Uniform Premium Requirements. With respect to the premiums charged to Members for Part C and/or Part D drug benefits, you may determine how much of a Member’s Part C and/or Part D monthly beneficiary premium you will subsidize, provided that: (i) if you subsidize different amounts for different classes of Members in a plan, such classes will be reasonable and based on objective business criteria, such as years of service, business location, job category and nature of compensation (for example, salaried and hourly), and different classes cannot be based on eligibility for the low-income subsidy; (ii) the premium will not vary for individuals within a given class of Members; and (iii) a Member cannot be charged more than the sum of their standard Part D beneficiary premium or the monthly beneficiary premium for basic benefits as defined in 42 CFR § §422.2 (i.e., all Medicare-covered benefits, except hospice services); and 100% of the monthly beneficiary premium for their non-Medicare Part C and/or Part D benefits (if any). You must pass through any direct subsidy payments received from CMS to reduce the amount the Member pays (or, in those instances when your employee pays premiums on behalf of their eligible spouse or covered dependent, the amount the employee pays). Low Income Subsidy (LIS). The low-income premium subsidy that CMS pays on behalf of an LIS-eligible Member must be passed through to the LIS-eligible Member. With respect to the premium contributions collected from your LIS-eligible Members, the monthly low-income premium subsidy will first be used to reduce that portion of the premium paid for by the LIS-eligible Member, with any remaining portion of the premium subsidy amount then used to reduce the employer’s premium contribution. You will be responsible for reducing up front the premium contribution amounts for your LIS-eligible Members. If you are not able to reduce an LIS-eligible Member’s premium contribution amount up front that has been previously paid by the LIS-eligible Member (or, your employee if they pay premiums on behalf of the LIS-eligible Member), you must directly refund the low-income premium subsidy amount up to the monthly premium contribution that you previously collected from the LIS-eligible Member (or, your employee, if applicable). You are required to refund the LIS-eligible Member (or, your employee, if applicable) within 45 days of the date Blue Cross and Blue Shield receives the low-income premium subsidy amount payment from CMS on behalf of your LIS-eligible Members.