Business Operations of the Exchange Sample Clauses

Business Operations of the Exchange. Exchanges must carry out several functions required by the Affordable Care Act. More detailed information will be provided on the requirements for each function in future guidance. Each of the minimum functions of an Exchange are listed below and explained in greater detail below. These requirements are mainly set forth in Sections 1311(d)(4), 1341, 1343, and 1411-1413. Minimum functions of an Exchange:  Certification, recertification, and decertification of qualified health plansCall centerExchange website  Premium tax credit and cost-sharing reduction calculator  Quality rating systemNavigator programEligibility determinations for Exchange participation, advance payment of premium tax credits, cost-sharing reductions, and Medicaid  Seamless eligibility and enrollment process with Medicaid and other State health subsidy programs  Enrollment process  Applications and notices  Individual responsibility determinationsAdministration of premium tax credits and cost-sharing reductions  Adjudication of appeals of eligibility determinations  Notification and appeals of employer liability  Information reporting to IRS and enrollees  Outreach and education  Free Choice Vouchers  Risk adjustment and transitional reinsurance  SHOP Exchange-specific functions Certification, Recertification, and Decertification of Qualified Health Plans Each Exchange, whether for the small group or individual market, must have a process in place to certify, recertify, and decertify qualified health plans. States must begin defining their process and approach to these activities with health plans in the early planning and establishment phases of an Exchange. There are many steps in this process, and we have provided milestones as a framework for carrying out these activities. However, States may be on slightly different timelines and we encourage States to develop timeframes for these activities that are achievable yet ensure they can be ready for open enrollment in mid to late 2013. In order to meet this deadline, Exchanges must begin the process of selection and certification of qualified health plans in 2012.
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Business Operations of the Exchange. As discussed in Kentucky’s second Level I Establishment Grant, the KHBE established workgroups that met over 35 times over several months to define the vision and operational plan for the KHBE. One outcome was the development of the KHBE Operating Model below, which can also be found in Appendix C: Operating Model. The operating model was an input to the system implementation RFP for KHBE’s Eligibly and Enrollment and a Plan Management and Billing Solutions (E&E and PBM). During the procurement phase, KHBE took strides to prepare for the system integrator by developing Kentucky based process flows for all functional areas of the exchange including eligibility, enrollment, plan management, and financial management.
Sample 1

Related to Business Operations of the Exchange

  • Business Operations Company will provide all necessary equipment, personnel and other appurtenances necessary to conduct its operations. Company will conduct its business operations hereunder in a lawful, orderly and proper manner, considering the nature of such operations, so as not to unreasonably annoy, disturb, endanger or be offensive to others on the Airport. Company will provide all services under this Agreement on a fair and reasonable basis to all users of the Airport. Service will be prompt, courteous and efficient.

  • OBLIGATIONS OF THE DATA CONTROLLER For the execution of the Service, the Data Controller undertakes the commitment to put at the disposal of the Data Processor the personal data and/or the information necessary for the appropriate processing of such data for the provision of the Services.

  • OBLIGATIONS OF THE EMPLOYER 9.1 The Employer shall-

  • Obligations of the Department a. The Department shall notify Business Associate of a) any limitation in any applicable Notice of Privacy Practices that would affect the use or disclosure of PHI by the Business Associate and b) any changes, revocations, restrictions or permissions by an individual to the use and disclosure of his/her PHI to which the Department has agreed, to the extent such restrictions or limitations may affect the performance of Business Associate’s services on behalf of the Department.

  • Management and Operations of the Borrower Section 4.01. The Borrower shall carry on its operations and conduct its affairs in accordance with sound administrative, financial, engineering and public utility practices under the supervision of qualified and experienced management assisted by competent staff in adequate numbers.

  • Operations As of the date hereof, the Company has not conducted, and prior to the IPO Closing the Company will not conduct, any operations other than organizational activities and activities in connection with offerings of its securities.

  • MANAGEMENT OF THE BUSINESS Pursuant to Section 00-00-000 of the Act, and as stated in its Articles, the Company’s day to day affairs are managed by the Member. The Member is responsible for the daily operations of the business.

  • Conditions of Eft Services (a.) Ownership of Card(s). Any Card we supply to you is our property and must be returned to us, or to any person whom we authorize to act as our agent, or to any person who is authorized to honor the Card, immediately according to instructions. The Card may be reclaimed at any time at our sole discretion without demand or notice. You cannot transfer your Card to another person.

  • FUNCTIONS OF MANAGEMENT 4.01 The Union agrees that the Employer has the exclusive right and power to manage its business to direct the working forces and to suspend, discharge or discipline employees for just and sufficient cause, to hire, promote, demote, transfer or lay-off employees, to establish and maintain reasonable rules and regulations covering the operation of the stores, provided however, that any exercise of these rights and powers in conflict with any of the provisions of this Agreement shall be subject to the provisions of the Grievance Procedure as set out herein.

  • Conditions of Use CLIENT acknowledges that its use of the Site is subject to and conditioned upon the following terms and agrees that TAILGATE GUYS may exercise any of the remedies set forth herein for CLIENTS failure to comply:

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