Coverage Following Termination and Decertification Sample Clauses

Coverage Following Termination and Decertification a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered California. This cooperation shall include: (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the succeeding contractor as applicable, as reasonably requested by Covered California. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disability. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or ...