Article 3 – QHP Issuer Program Requirements

3.1.3 Accreditation

b) Contractor shall be currently accredited and maintain its NCQA, URAC or AAAHC health plan accreditation throughout the term of the Agreement. Contractor shall notify the Exchange of the date of any accreditation review scheduled during the term of this Agreement and the results of such review. Upon completion of any health plan accreditation review conducted during the term of this Agreement, Contractor shall provide the Exchange with a copy of the Assessment Report within forty-five (45) days of report receipt.

c) If Contractor receives a rating of less than “accredited” in any category, loses an accreditation, or fails to maintain a current and up to date accreditation, Contractor shall notify the Exchange within ten (10) business days of such rating(s) change and shall be required to provide the Exchange with all corrective action(s). Contractor will implement strategies to raise the Contractor’s rating to a level of at least “accredited” or to reinstate accreditation. Contractor will submit a written corrective action plan (CAP) to the Exchange within forty-five (45) days of receiving its initial notification of the change in category ratings.

d) Following the initial submission of the corrective action plans (“CAPs”), Contractor shall provide a written report to the Exchange on at least a quarterly basis regarding the status and progress of the submitted corrective action plan(s). Contractor shall request a follow-up review by the accreditation entity at the end of twelve (12) months and submit a copy of the follow-up Assessment Report to the Exchange within thirty (30) days of receipt, if applicable.

e) In the event Contractor’s overall accreditation is suspended, revoked, or otherwise terminated, or in the event Contractor has undergone review prior to the expiration of its current accreditation and reaccreditation is suspended, revoked, or not granted at the time of expiration, the Exchange reserves the right to terminate any agreement by and between Contractor and the Exchange or suspend enrollment in Contractor’s QHPs, to ensure the Exchange is in compliance with the federal requirement that all participating issuers maintain a current approved accreditation.

f) Upon request by the Exchange, Contractor will identify all health plan certification or accreditation programs undertaken, including any failed accreditation or certifications, and will also provide the full written report of such certification or accreditation undertakings to the Exchange.

3.1.4 Plan Naming Conventions

Contractor mustwill adhere to using Covered California’s Plan Naming Conventions on all Regulator plan filings, marketing material, Enrollee material, and SERFF submissions.

3.1.5 Operational Requirements and Liquidated Damages

The timely and accurate submission of Contractor’s QHP filings and documents to Covered California to upload into CalHEERS is critical to the successful launch of each Open Enrollment Period. When submissions are late, or inaccurate, Covered California suffers financial harm with each resubmission and such actions put the renewal and open enrollment process at risk. Therefore, Contractor mustwill meetcomplete the following operational requirements by the applicable deadline. Contractor agrees that it will pay Covered California liquidated damages in the amount of $50,000 for each failure to meet the submission requirements by the applicable due date as follows:. accurately, and by the required deadline:

SERFF Template Completion Due Date: 5/2/2017

Contractor is required to submit complete and accurate SERFF Templates to Covered California accurately by May 2, 2017. More than two rounds of validation required to correct errors and unapproved changes made to templates after submission to the Exchange will result in a liquidated damages penalty in the amount of $50,000 for each additional round of verification or an unapproved change to the templatesis not acceptable.

CALHEERS load and test deadlines Due Date: TBD

Contractor is required to upload complete and accuratewill meet deadline for SERFF templates, SBCs, EOCs and other policy documents upload to CALHEERS by [Date TBD]. Uploads made later than the due date and errors requiring additional uploads beyond the due date will result in a liquidated damags penalty in the amount of $50,000 for each document uploaded beyond the due date and for each document that has to be uploaded again due to Contractor’s error.Errors identified in Plan Data, or Plan Documents in the production environment are not acceptable.

3.1.6 Additional Operational Requirements

Contractor must meet the following operational requirements:

Deadlines for regulatory approval Due Date: TBD

Contractor is required to will receivemeet regulatory approvaldeadlines for Licensure, submission of rates, products, SBCs/EOCs, policy documents, Network, and Service Area.

Communication with Plan Manager/the Exchange

Contractor will notify the Exchange in a timely manner of changes with operational impacts to the Exchange, negative impacts to members, CALHEERS impact (e.g. vendor change). Contractor and the Exchange will work together and communicate frequently about changes or potential business impacts to the Exchange or members.

Failure to meet the above requirements resulting in the need to initiate a supplemental CALHEERS upload, due to Contractor providing erroneous data, or Contractor delay, will result in liquidated damages of $50,000. The Exchange also reserves the right to utilize additional remedies listed in Section 7.2.4.
Please note: Items highlighted above will be provided prior to the finalization of this Contract

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