Common use of Enrollee Hold Harmless Clause in Contracts

Enrollee Hold Harmless. If required under a Payor Contract or law, in no event, including but not limited to nonpayment by a Payor or HMHP (if applicable), insolvency of the Payor or HMHP or breach of the Payor Contract or this Agreement, shall Practice or Participating Physicians, or their assignees or subcontractors, xxxx, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against an Enrollee for Covered Services provided pursuant to a Payor Contract other than as provided in Section 4 above. The requirements of this Section 5 shall survive any termination of this Agreement or applicable Payor Contract for Covered Services. This clause supersedes any oral or written agreement now existing or hereafter entered into between the Parties and the Enrollee or person acting on the Enrollee’s behalf. This provision shall not prohibit the collection of payment for any non-Covered Services or amounts available through coordination of benefits in accordance with the terms of this Agreement and HMHP’s Policies and Procedures. EXHIBIT A PARTICIPATING PHYSICIANS AND PRACTITIONERS Listed below are the Practice’s Participating Physicians and Practitioners (Nurse Practitioner, Physician Assistant, Midwife). Practice agrees to update this list as changes occur during the Term (e.g.: TIN, NPI, new hire, resignations, terminations, mergers, acquisitions, address, phone number). All questions below must be completed. Name of Participating Physician / Practitioner National Provider Identifier (NPI) E-mail Address Phone # Does the Practice and its Physicians and Practitioners use an Electronic Medical Record (EMR)? Yes / No If yes, which EMR? Circle your EMR’s certification: Certified Electronic Health Record Technology (CEHRT) Certification Commission for Health Information Technology (CCHIT) ONC Health IT Certification Program (Program) None of the above Name E-mail Address Phone # Primary Practice Contact Primary Billing / Finance Contact EXHIBIT B BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE ADDENDUM (the “Agreement” or “BAA”) supplements and is made a part of the Participating Physician Practice Agreement (“Underlying Agreement”) by and between Practice (“Covered Entity”) and Hackensack Meridian Health Partners (“Business Associate”) and is effective as of the effective date of the Underlying Agreement (the “Effective Date”). Covered Entity and Business Associate are sometimes referred to herein as the “Parties,” or individually as a “Party.”

Enrollee Hold Harmless. If required under a Payor Contract or law, in no event, including but not limited to nonpayment by a Payor or HMHP (if applicable), insolvency of the Payor or HMHP or breach of the Payor Contract or this Agreement, shall Practice or Participating Physicians, or their assignees or subcontractors, xxxx, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against an Enrollee for Covered Services provided pursuant to a Payor Contract other than as provided in Section 4 above. The requirements of this Section 5 shall survive any termination of this Agreement or applicable Payor Contract for Covered Services. This clause supersedes any oral or written agreement now existing or hereafter entered into between the Parties and the Enrollee or person acting on the Enrollee’s behalf. This provision shall not prohibit the collection of payment for any non-Covered Services or amounts available through coordination of benefits in accordance with the terms of this Agreement and HMHP’s Policies and Procedures. EXHIBIT A PARTICIPATING PHYSICIANS AND PRACTITIONERS Listed below are the Practice’s Participating Physicians and Practitioners (Nurse Practitioner, Physician Assistant, Midwife). Practice agrees to update this list as changes occur during the Term (e.g.: TIN, NPI, new hire, resignations, terminations, mergers, acquisitions, address, phone number). All questions below must be completed. Name of Participating Physician / Practitioner National Provider Identifier (NPI) E-mail Address Phone # Primary Specialty Does the Practice and its Physicians and Practitioners use an Electronic Medical Record (EMR)? Yes / No If yes, which EMR? Circle your EMR’s certification: Certified Electronic Health Record Technology (CEHRT) Certification Commission for Health Information Technology (CCHIT) ONC Health IT Certification Program (Program) None of the above Name E-mail Address Phone # Primary Practice Contact Primary Billing / Finance Contact EXHIBIT B BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE ADDENDUM (the “Agreement” or “BAA”) supplements and is made a part of the Participating Physician Practice Agreement (“Underlying Agreement”) by and between Practice (“Covered Entity”) and Hackensack Meridian Health Partners (“Business Associate”) and is effective as of the effective date of the Underlying Agreement (the “Effective Date”). Covered Entity and Business Associate are sometimes referred to herein as the “Parties,” or individually as a “Party.”

Enrollee Hold Harmless. If required under a Payor Contract or law, in In no event, including but not limited to nonpayment by a Payor or HMHP (if applicable), insolvency of the Payor or HMHP or breach of the Payor Contract or this Agreement, shall Practice or Participating PhysiciansPractice, or their its assignees or subcontractors, xxxxbill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against an Enrollee for Covered Services provided pursuant to a Payor Contract other than as provided in Section 4 above. The requirements of this Section 5 shall survive any termination of this Agreement or applicable Payor Contract for Covered Services. This clause supersedes any oral or written agreement now existing or hereafter entered into between the Parties and the Enrollee or person acting on the Enrollee’s behalf. This provision shall not prohibit the collection of payment for any non-Covered Services or amounts available through coordination of benefits in accordance with the terms of this Agreement and HMHP’s Policies and Procedures. The requirements of this Section 5 shall apply to all Payor Contracts subject to NJAC 11:24B-5.2(a)(10), and to such self-insured ERISA Payor Contracts that include an analogous employee/member hold harmless provision in their plan design. EXHIBIT A PARTICIPATING PHYSICIANS AND PRACTITIONERS Listed below are the Practice’s Participating Physicians and Practitioners (Nurse Practitioner, Physician Assistant, Midwife). Practice agrees to update this list as changes occur during the Term (e.g.: TIN, NPI, new hire, resignations, terminations, mergers, acquisitions, address, phone number). All questions below must be completed. Name of Participating Physician / Practitioner National Provider Identifier (NPI) E-mail Address Phone # Primary Specialty Does the Practice and its Physicians and Practitioners use an Electronic Medical Record (EMR)? Yes / No If yes, which EMR? Circle your EMR’s certification: Certified Electronic Health Record Technology (CEHRT) Certification Commission for Health Information Technology (CCHIT) ONC Health IT Certification Program (Program) None of the above Name E-mail Address Phone # Primary Practice Contact Primary Billing / Finance Contact EXHIBIT B BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE ADDENDUM (the “Agreement” or “BAA”) supplements and is made a part of the Participating Physician Practice Agreement (“Underlying Agreement”) by and between Practice (“Covered Entity”) and Hackensack Meridian Health Partners (“Business Associate”) and is effective as of the effective date of the Underlying Agreement (the “Effective Date”). Covered Entity and Business Associate are sometimes referred to herein as the “Parties,” or individually as a “Party.”

Enrollee Hold Harmless. If required under a Payor Contract or law, in In no event, including but not limited to nonpayment by a Payor or HMHP (if applicable), insolvency of the Payor or HMHP or breach of the Payor Contract or this Agreement, shall Practice or Participating PhysiciansPractice, or their its assignees or subcontractors, xxxx, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against an Enrollee for Covered Services provided pursuant to a Payor Contract other than as provided in Section 4 above. The requirements of this Section 5 shall survive any termination of this Agreement or applicable Payor Contract for Covered Services. This clause supersedes any oral or written agreement now existing or hereafter entered into between the Parties and the Enrollee or person acting on the Enrollee’s behalf. This provision shall not prohibit the collection of payment for any non-Covered Services or amounts available through coordination of benefits in accordance with the terms of this Agreement and HMHP’s Policies and Procedures. The requirements of this Section 5 shall apply to all Payor Contracts subject to NJAC 11:24B-5.2(a)(10), and to such self-insured ERISA Payor Contracts that include an analogous employee/member hold harmless provision in their plan design. EXHIBIT A PARTICIPATING PHYSICIANS AND PRACTITIONERS Listed below are the Practice’s Participating Physicians and Practitioners (Nurse Practitioner, Physician Assistant, Midwife). Practice agrees to update this list as changes occur during the Term (e.g.: TIN, NPI, new hire, resignations, terminations, mergers, acquisitions, address, phone number). All questions below must be completed. Name of Participating Physician / Practitioner National Provider Identifier (NPI) E-mail Address Phone # Primary Specialty Does the Practice and its Physicians and Practitioners use an Electronic Medical Record (EMR)? Yes / No If yes, which EMR? Circle your EMR’s certification: Certified Electronic Health Record Technology (CEHRT) Certification Commission for Health Information Technology (CCHIT) ONC Health IT Certification Program (Program) None of the above Name E-mail Address Phone # Primary Practice Contact Primary Billing / Finance Contact EXHIBIT B BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE ADDENDUM (the “Agreement” or “BAA”) supplements and is made a part of the Participating Physician Practice Agreement (“Underlying Agreement”) by and between Practice (“Covered Entity”) and Hackensack Meridian Health Partners (“Business Associate”) and is effective as of the effective date of the Underlying Agreement (the “Effective Date”). Covered Entity and Business Associate are sometimes referred to herein as the “Parties,” or individually as a “Party.”

Enrollee Hold Harmless. If required under a Payor Contract or law, in no event, including but not limited to nonpayment by a Payor or HMHP (if applicable), insolvency of the Payor or HMHP or breach of the Payor Contract or this Agreement, shall Practice or Participating Physicians, or their assignees or subcontractors, xxxx, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against an Enrollee for Covered Services provided pursuant to a Payor Contract other than as provided in Section 4 above. The requirements of this Section 5 shall survive any termination of this Agreement or applicable Payor Contract for Covered Services. This clause supersedes any oral or written agreement now existing or hereafter entered into between the Parties and the Enrollee or person acting on the Enrollee’s behalf. This provision shall not prohibit the collection of payment for any non-Covered Services or amounts available through coordination of benefits in accordance with the terms of this Agreement and HMHP’s Policies and Procedures. EXHIBIT A PARTICIPATING PHYSICIANS AND PRACTITIONERS Listed below are the Practice’s Participating Physicians and Practitioners (Nurse Practitioner, Physician Assistant, Midwife). Practice agrees to update this list as changes occur during the Term (e.g.: TIN, NPI, new hire, resignations, terminations, mergers, acquisitions, address, phone number). All questions below must be completed. Name of Participating Physician / Practitioner National Provider Identifier (NPI) E-mail Address Phone # Primary Specialty Does the Practice and its Physicians and Practitioners use an Electronic Medical Record (EMR)? Yes / No If yes, which EMR? Circle your EMR’s certification: Certified Electronic Health Record Technology (CEHRT) Certification Commission for Health Information Technology (CCHIT) ONC Health IT Certification Program (Program) None of the above Name E-mail Address Phone # Primary Practice Contact Primary Billing / Finance Contact EXHIBIT B BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE ADDENDUM (the “Agreement” or “BAA”) supplements and is made a part of the Participating Physician Practice Agreement (“Underlying Agreement”) by and between Practice (“Covered Entity”) and Hackensack Meridian Health Partners (“Business Associate”) and is effective as of the effective date of the Underlying Agreement (the “Effective Date”). Covered Entity and Business Associate are sometimes referred to herein as the “Parties,” or individually as a “Party.”