new employees’ eligibility for health coverage, e.g. new hires or an employee who switched from part time to full time
Provide written notification to HP/OHCA on the INSURE OKLAHOMA-4 (Small Business Employer Change Form) within seven working days of being informed of any qualifying event that changes the employee or spouse’s eligibility for health coverage.
Comply with all applicable federal and state statutes and regulations, OHCA rules and HP policies.
Give HP and OHCA the right to access any payment, coverage, or other EMPLOYER-related records of EMPLOYER’S carrier.
Assist OHCA and HP in determining the liability of third parties for any INSURE OKLAHOMA employee’s health care expenditures in accordance with 42 U.S.C. 1396a (25) (A)
Provide information to OHCA related to EMPLOYER’s expenditures for group health care coverage and benefit plans offered in the previous five years so that OHCA can comply with federal reporting requirements.
Accept payment from HP by direct deposit to the EMPLOYER’s financial institution and ensure that HP/OHCA has correct direct deposit information.
PAYMENT OF THE PREMIUM SUBSIDY
HP shall pay EMPLOYER a monthly subsidy amount as shown on the “Employee Approved–Inform Employer Letter” PMS-9003-D for health premiums for its eligible employees enrolled in INSURE OKLAHOMA.
HP/OHCA shall make payment in accordance with the direct deposit information supplied by EMPLOYER.
In the event of an overpayment to EMPLOYER due to fraud or error, HP/OHCA will recoup the amount of the overpayment from EMPLOYER. Overpayments will be recouped by deduction from future premium subsidies and/or creating an account receivable and invoicing EMPLOYER for a payment. The date of any notice
of adverse action issued by OHCA or HP HP/OHCA’s ability to recoup overpayments All payments will be from federal and
to an employee enrolled in INSURE OKLAHOMA has no bearing on
concealment of a material fact may be prosecuted under applicable federal or state laws.
EMPLOYER agrees and understands that HP/OHCA cannot make payment to employers who discriminate on the grounds of race, color, religion, sex, national origin or handicap. BILLING PROCEDURES
EMPLOYER agrees to submit its claim for a subsidy payment in a format acceptable to HP/OHCA and attach a complete premium invoice from the carrier.
EMPLOYER agrees to submit the claim on a monthly basis at least five (5) days prior to the monthly premium cycle cut-off date as published in the Employer Invoice Calendar contained in EMPLOYER’s enrollment packet.
In the event that the carrier invoice shows that full payment of the previous month’s invoice has not been made and EMPLOYER has received a premium subsidy for that previous month, the subsidy payment for the current month may be delayed.
If no claim and carrier invoice is received for a particular month, HP/OHCA may at its option assume that the employer is no longer participating in INSURE OKLAHOMA and terminate EMPLOYER’s Agreement.
ARTICLE V. LAWS APPLICABLE
The parties to this Agreement acknowledge and expect that over the term of this Agreement laws may change. Specifically, the parties acknowledge and expect (i) federal Medicaid statutes and regulations and (ii) state Medicaid and INSURE OKLAHOMA statutes and rules may change. The parties shall be mutually bound by such changes.
The explicit inclusion of some statutory and regulatory duties in this Agreement shall not exclude other statutory or regulatory duties.
All questions pertaining to validity, interpretation, and administration of this Agreement shall be determined in accordance with the laws of the State of Oklahoma, regardless of where any service is performed or product is provided.
The venue for civil actions arising from this Agreement shall be Oklahoma County, Oklahoma. For the purpose of rightful Federal jurisdiction, in any action in which the State of Oklahoma is a party, venue shall be United States District Court for the Western District of Oklahoma.
ARTICLE VI. AUDIT AND INSPECTION
EMPLOYER shall keep such records as are necessary to disclose fully the extent of its participation in the INSURE OKLAHOMA program and shall furnish records and information regarding eligibility requirements, employee status, and subsidy payments received to HP, OHCA, the Oklahoma Attorney General’s Medicaid Fraud Control Unit (MFCU hereafter), and the U.S. Secretary of Health and Human Services (Secretary hereafter) for six years from the date of provision. EMPLOYER shall not destroy or dispose of records, which are under audit, review or investigation when the six-year limitation is met. EMPLOYER shall maintain such records until informed in writing by the auditing, reviewing or investigating agency that the audit, review or investigation is complete. Authorized representatives of the HP, OHCA, MFCU, and the Secretary shall have the right to make physical inspection of EMPLOYER’s place of business and to examine records relating to financial statements or forms submitted
Insure Oklahoma/HP/Employer Contract 7-8-11