1095-C Clause Samples

1095-C. Description The DEPARTMENT reserves the right to require the CONTRACTOR to assist with developing and mailing the federally required 1095-Cs. (See Section 205B.) Due As needed 315 Performance Standards and Penalties‌ Performance standards are specific to data from the HEALTH BENEFIT PROGRAM, not general data from the CONTRACTOR’S book-of-business. The CONTRACTOR must track performance using the template provided by the DEPARTMENT. The CONTRACTOR must submit reports and supporting documentation for validation as mutually agreed upon with the DEPARTMENT. The CONTRACTOR shall notify the DEPARTMENT upon realization that a standard will not be met, prior to the deadline. The penalties assessed in Section 150B and Section 315 shall not exceed three percent (3%) of the CONTRACTOR’S total medical premium in any given quarter. Performance standards will be measured by the DEPARTMENT on a QUARTERLY basis. The DEPARTMENT reserves the right to waive a penalty in certain circumstances when the DEPARTMENT determines it is warranted. The performance categories and associated penalty are shown below and explained in greater detail in the tables that follow: 315A Claims Processing‌ The CONTRACTOR shall report monthly values on a QUARTERLY basis for these standards.
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Related to 1095-C

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