Common use of Payments for Coverage Clause in Contracts

Payments for Coverage. Monthly Premium Charge Under this Agreement, you will pay a monthly premium charge for each enrolled membership in exchange for health care benefits provided by Blue Cross and Blue Shield. You must pay the total of all billed premium charges to Blue Cross and Blue Shield by the due date indicated on each monthly invoice. If full payment of premium charges is not received on or before the due date, Blue Cross and Blue Shield will suspend all claim payments as of the last date through which you have paid premium charges to Blue Cross and Blue Shield. In certain situations, premium rates may be subject to review by appropriate regulatory authorities. In the event that you are billed a premium rate that is higher or lower than a rate subsequently approved by a governing regulatory or judicial authority, Blue Cross and Blue Shield reserves the right to make appropriate adjustments retroactive to the beginning of your policy year or effective date of the premium rate adjustment. In addition, there may be times when Blue Cross and Blue Shield reduces your premium rate if you elect to combine your benefits plans offered under this Agreement along with certain other Blue Cross and Blue Shield ancillary products such as standalone dental and/or vision plans. In the event you elect to offer a Medicare Advantage plan, you agree that the Medicare Advantage plan’s benefits change on a calendar year basis. As a result, your Medicare Advantage plan’s premium charge may change on each January 1 during your policy year. Since these premium charges have to be approved in advance by the Centers for Medicare and Medicaid Services (CMS), Blue Cross and Blue Shield will make a good faith effort to give you 30 days prior written notice of any change in your premium charge. However, if Blue Cross and Blue Shield does not receive CMS approval in time, Blue Cross and Blue Shield may not be able to give you 30 days prior notice. In this case, Blue Cross and Blue Shield will give you written notice of the change in the Medicare Advantage plan’s premium charge as soon as possible.

Payments for Coverage. Monthly Premium Charge Under this Agreement, you will pay a monthly premium charge for each enrolled membership in exchange for health care benefits provided by Blue Cross and Blue Shield. You must pay the total of all billed premium charges to Blue Cross and Blue Shield by the due date indicated on each monthly invoice. If full payment of premium charges is not received on or before the due date, Blue Cross and Blue Shield will suspend all claim payments as of the last date through which you have paid premium charges to Blue Cross and Blue Shield. In certain situations, premium rates may be subject to review by appropriate regulatory authorities. In the event that you are billed a premium rate that is higher or lower than a rate subsequently approved by a governing regulatory or judicial authority, Blue Cross and Blue Shield reserves the right to make appropriate adjustments retroactive to the beginning of your policy year or effective date of the premium rate adjustment. In addition, there may be times when Blue Cross and Blue Shield reduces your premium rate if you elect to combine your benefits plans offered under this Agreement along with certain other Blue Cross and Blue Shield ancillary products such as standalone dental and/or vision plans. In the event you elect to offer a Medicare Advantage plan, you agree that the Medicare Advantage plan’s benefits change on a calendar year basis. As a result, your Medicare Advantage plan’s premium charge may change on each January 1 during your policy year. Since these premium charges have to be approved in advance by the Centers for Medicare and Medicaid Services (CMS), Blue Cross and Blue Shield will make a good faith effort to give you 30 days prior written notice of any change in your premium charge. However, if Blue Cross and Blue Shield does not receive CMS approval in time, Blue Cross and Blue Shield may not be able to give you 30 days prior notice. In this case, Blue Cross and Blue Shield will give you written notice of the change in the Medicare Advantage plan’s premium charge as soon as possible.

Payments for Coverage. Monthly Premium Charge Under this Agreement, you acknowledge and agree that you will pay a monthly premium charge for each enrolled membership in exchange for health care benefits provided by Blue Cross and Blue Shield. You must pay the total of all billed premium charges to Blue Cross and Blue Shield by the due date indicated on each monthly invoice. If full payment of premium charges is not received on or before the due date, Blue Cross and Blue Shield will suspend all claim payments as of the last date through which you have paid premium charges to Blue Cross and Blue Shield. In certain situations, premium rates may be subject to review by appropriate regulatory authorities. In the event that you are billed a premium rate that is higher or lower than a rate subsequently approved by a governing regulatory or judicial authority, you acknowledge and agree that Blue Cross and Blue Shield reserves the right to make appropriate adjustments retroactive to the beginning of your policy year or effective date of the premium rate adjustment. In addition, you acknowledge and agree that there may be times when Blue Cross and Blue Shield reduces your premium rate if you elect to combine your benefits plans offered under this Agreement along with certain other Blue Cross and Blue Shield ancillary products such as standalone dental and/or vision plans. In the event you elect to offer a Medicare Advantage plan, you acknowledge and agree that the Medicare Advantage plan’s benefits change on a calendar year basis. As a result, your Medicare Advantage plan’s premium charge may change on each January 1 during your policy year. Since these premium charges have to be approved in advance by the Centers for Medicare and Medicaid Services (CMS), Blue Cross and Blue Shield will make a good faith effort to give you 30 days prior written notice of any change in your premium charge. However, if Blue Cross and Blue Shield does not receive CMS approval in time, Blue Cross and Blue Shield may not be able to give you 30 days prior notice. In this case, Blue Cross and Blue Shield will give you written notice of the change in the Medicare Advantage plan’s premium charge as soon as possible.