Premiums for Coverage in Covered California. for the Individual Market Contractor shall not be entitled to collect from Enrollees or receive funds above the premium amounts except with respect to cost-sharing amounts or to the extent that such payment (i) is expressly authorized under the QDPs, such as out-of-network services that comply with the notice requirements set forth at Section 3.4.3, or (ii) relates to a charge for non-sufficient funds or transaction fees initiated by Enrollee at rates that are reasonable and customary for such transactions; the Contractor shall not pursue collections of any said fees from Covered California. Premium charged to individuals includes the assessment of the participation fee, (see Section 5.1.3 Participation Fee). Contractor shall not pursue collection of any delinquent premiums from Covered California for an Enrollee enrolled in Covered California for the Individual Market who is responsible for directly paying for his or her premium to Contractor. In the case of partial month enrollments Contractor shall follow the methodology specified in 10 CCR § 6500(i). The premium for coverage lasting less than one month shall equal the product of:
Appears in 4 contracts
Samples: Qualified Dental Plan Issuer Contract, Qualified Dental Plan Issuer Contract, Qualified Dental Plan Issuer Contract
