Consolidated Appropriations Act (CAA) Gag Clause Prohibition Compliance Attestation Opt-in form

Complete and submit by November 22, 2024.

ASO groups:

The Gag Clause Prohibition Compliance Attestation covers the period of November 1, 2023 through October 1, 2024.

If you would like Capital Blue Cross to submit the attestation on your group’s behalf for this time period, please complete and submit this form by November 22, 2024. If you submit multiple responses to the questions, your most recent response will be used in our final submission to CMS.

This form must be filled out by a legally authorized employee of the group and will not be accepted from a broker or consultant. If you have any questions about this submission, please contact your Account Executive. Learn more about the Gag Clause Prohibition Compliance Attestation.

Thank you.

Required fields are noted with an asterisk. *

By checking the boxes below, you are certifying, as a legally authorized employee of the employer group health plan (Plan), that:
 
1. You are explicitly directing Capital Blue Cross (Capital), and Capital agrees as the Plan's Third Party Administrator (TPA), to submit the annual Gag Clause Prohibition Compliance Attestation (GCPCA) on the Plan's behalf, in compliance with Internal Revenue Code (Code) section 9824, Employee Retirement Income Security Act (ERISA) section 724, and Public Health Service (PHS) Act section 2799A-9, as added by the Consolidated Appropriations Act, 2021 (CAA), as applicable (Gag Clause Statutory Requirements) by December 31, 2024.
 
2. You understand that while you are consenting to have Capital submit the GCPCA on the Plan's behalf, the Plan has sole legal responsibility for its compliance with the Gag Clause Statutory Requirements.
 
3. You represent and warrant that the Plan is, and at all times since November 1, 2023 has been, compliant with the Gag Clause Statutory Requirements with regard to any and all agreements between the Plan and any healthcare provider, network or association of providers, TPA, or other service provider offering access to a network of providers subject to the Gag Clause Statutory Requirements.
 
4. You understand and agree that in submitting the attestation on the Plan's behalf, Capital will rely entirely on your representation and warranty in paragraph 3, above, unless and until the you instruct Capital otherwise in writing.
 
5. The Plan hereby agrees to defend, indemnify, and hold Capital harmless from and against any and all claims, demands, actions, settlements, losses or judgments, including attorneys' fees and litigation expenses, arising out of or related in any way to the completion and submission of the attestation by Capital on behalf of the Plan in accordance with this agreement. The Plan agrees to inform Capital within thirty (30) days of its receipt of any claim, demand, or notice for which indemnification may be sought under this agreement, and to cooperate in the investigation and defense of any such claim notice.
I understand that by typing my name and information below I agree to all of the above.
If multiple submissions are received, we will utilize the most recent submission.
 

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Thank you for your submission of the CAA Gag Clause Prohibition Compliance Attestation Opt-In form. Please save this confirmation for your records. We will notify you through our CAA page when we have completed our submission to CMS in mid-to-late December.

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