Recitals 2 Article 1 General Provisions 4 a 1 Purpose 4 b 2 Applicable Law and Regulation 4
at)7.6 Coverage Following Termination and Decertification
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- 8.1.2 Workers’ Compensation
- 8.1.3 Subcontractor Coverage
- 8.1.4 Continuation of Required Coverage
- 8.1.5 Premium Payments and Disclosure
at)7.6 Coverage Following Termination and Decertificationa) Upon the termination of the Agreement orand decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with the Exchange in order to effect an orderly transition of Enrollees to another QHP as directed by the Exchange. This cooperation shall include, without limitation: (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and/or (iii) communicating with affected Enrollees in cooperation with the Exchange and/or the succeeding contractor as applicable, each as shall be reasonably requested by the Exchange. b) In the event of the termination or expiration of the Agreement requires the transfer of some or all Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of Enrollee under Contractor’s QHP may be extended to the extent that an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disability pursuant to Health and Safety Code section 1399.62. For purposes of this Agreement, “disability” means that the Enrollee has been certified as being totally disabled by the Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) days from the date coverage is terminated. Recertification of Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Enrollee’s enrollment in a replacement plan; or iv. Recertification.
au)7.7 Termination Due to Contractor Merger
Article 8 –Insurance and Indemnificationav)8.1 Contractor Insurance8.1.1 Required Coveragea) Without limiting the Exchange’s right to obtain indemnification or other form of remedies or relief from Contractor or other third-parties, Contractor shall, at its sole cost and expense, obtain, and, during the term of this Agreement, maintain, in full force and effect, the insurance coverage described in this Section and/or as otherwise required by law, including, without limitation, coverage required to be provided and documented pursuant to Section 1351 (o) of the Health and Safety Code and relating to insurance coverage or self-insurance: (i) to respond to claims for damages arising out of the furnishing of Covered Services, (ii) to protect against losses of facilities where required by the director, and (iii) to protect against workers’ compensation claims arising out of work-related injuries that might be brought by the eEmployees and staff of Contractor. All insurance shall be adequate to provide coverage against losses and liabilities attributable to the acts or omissions of Contractor in performance of this Agreement and to otherwise protect and maintain the resources necessary to fulfill Contractor’s obligations under this Agreement. The minimum acceptable limits shall be as indicated below: i. Commercial general liability or equivalent self-insurance covering the risks of bodily injury (including death), property damage and personal injury, including coverage for contractual liability, with a limit of not less than $1 million per occurrence/$2 million general aggregate; ii. Comprehensive business automobile liability (owned, hired, or non-owned vehicles used by Contractor in connection with performance of its obligations under this Agreement) covering the risks of bodily injury (including death) and property damage, including coverage for contractual liability, with a limit of not less than $1 million per accident; iii. Employers liability insurance covering the risks of Contractor’s eEmployees and eEmployees’ bodily injury by accident or disease with limits of not less than $1 million per accident for bodily injury by accident and $1 million per employee for bodily injury by disease and $1 million disease policy limit; iv. Umbrella policy providing excess limits over the primary general liability, automobile liability and employer’s liability policies in an amount not less than $10 million per occurrence and in the aggregate; v. Crime coverage at such levels consistent with industry standards and reasonably determined by Contractor to cover occurrences falling in the following categories: computer and funds transfer fraud; forgery; money and securities; and employee theft; and vi. Professional liability or errors and omissions with coverage of not less than $1 million per claim/$2 million general aggregate.
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