Individual Exchange definition
Examples of Individual Exchange in a sentence
The Monthly Rates for the Individual Exchange for Plan Year 2023 and the annual update for Plan Years 2024, and 2025 are those rates submitted by Contractor during the Certification Process and subsequently uploaded and validated by Contractor through the SERFF Templates for each Plan Year.
The provisions of this Section 5.01 shall apply with respect to the Individual Exchange.
QHP Issuers are solely responsible for compensating Agencies and Agents for plans sold in the Individual Exchange.
Contractor shall not pursue collection of any delinquent premiums from the Exchange for an Enrollee enrolled in the Individual Exchange who is responsible for directly paying for his/her premium to Contractor.
Contractor agrees to accept new Employers and Employees in SHOP and individual Enrollees in the Individual Exchange who enroll during these periods.
The parties acknowledge that (1) the Agreement does not contemplate any mid-year rate changes for the Individual Exchange in the ordinary course of business, and (2) the annual negotiation process must be supported by Contractor through the submission of information in such form and at such date as shall be established by the Exchange to provide Contractor with sufficient time for necessary analysis and actuarial certification.
For the Individual Exchange, rates shall be established through an annual negotiation process between the Contractor and the Exchange and are set for the following calendar year.
Contractor recognizes that the total cost of all Participation Fees for the Exchange must be collected by Contractor by spreading the cost across the premiums charged to Contractor’s entire individual risk pool (both inside and outside the Exchange) for the Individual Exchange Participation Fees and across the small employer risk pool (both inside and outside the Exchange) for SHOP Participation Fees.
The provisions of this Section 3.22(a) shall apply with respect to the Individual Exchange.
Network and Out-of-Network Benefits To obtain Benefits, you must receive Covered Health Care Services from a UnitedHealthcare Individual Exchange Network provider.