AIDS Reinsurance Sample Clauses
The AIDS Reinsurance clause is designed to address the allocation of risk related to claims arising from AIDS or HIV-related conditions within a reinsurance agreement. Typically, this clause specifies whether and how losses attributable to AIDS are covered, often setting limits, exclusions, or special terms for such claims. For example, it may exclude AIDS-related claims from coverage entirely or cap the insurer's liability for such losses. The core function of this clause is to manage the financial exposure of reinsurers to potentially high and unpredictable claims associated with AIDS, thereby ensuring clarity and stability in the reinsurance relationship.
AIDS Reinsurance. Professional, institutional, and pharmacy costs for AIDS Members shall be the financial responsibility of HMO, as set forth in the Operations Manual. Additionally, the pharmacy cost for HIV drugs shall be the financial responsibility of HMO under this Program. PPG shall receive prior authorization from HMO for an elective inpatient admission of an AIDS Member. In addition, PPG shall provide HMO with timely notification of any urgent/emergent admission of any AIDS Member who is receiving anti-viral home treatments, or of any AIDS Member who is receiving total parenteral nutrition. For purposes of this paragraph, timely notification is within twenty-four (24) hours of an admission or the initial treatment. In the event PPG fails to notify HMO as set forth in this paragraph, AIDS related claims for such Members shall not be eligible for payment under this Program.
AIDS Reinsurance. As further defined in Section B.4 of this Addendum, the AIDS Reinsurance rate shall be $0.56 PMPM, which shall be deducted from PPG’s Capitation and $0.38 PMPM shall be deducted from PPG’s Professional Out-of-Network Risk Sharing Budget. For the subsequent years, these deductions shall fluctuate to correspond with the Professional Out-of-Network Withhold percentage change.
AIDS Reinsurance. Professional, institutional, and pharmacy costs for AIDS Members shall be the financial responsibility of HEALTH NET, as set forth in the Operations Manual. Additionally, the pharmacy cost for HIV drugs shall be the financial responsibility of HEALTH NET under this Program. PPG shall receive prior authorization from HEALTH NET for an elective inpatient admission of an AIDS Member. In addition, PPG shall provide HEALTH NET with timely notification of any urgent/emergent admission of any AIDS Member who is receiving anti-viral home treatments, or of any AIDS Member who is receiving total parenteral nutrition. For purposes of this paragraph, timely notification is within twenty-four (24) hours of an admission or the initial treatment. In the event PPG fails to notify HEALTH NET as set forth in this paragraph, AIDS related claims for such Members shall not be eligible for payment under this Program.
AIDS Reinsurance. AIDS Reinsurance shall only be applicable for Healthy Families Adults age 21 and over. Professional, institutional, and pharmacy costs for AIDS Members shall be the financial responsibility of HEALTH NET as set forth in the Operations Manual. Additionally, the pharmacy cost for HIV drugs shall be the financial responsibility of HEALTH NET under this Program. PPG shall receive prior authorization from HEALTH NET for an elective inpatient admission of an AIDS Member. In addition, PPG shall provide HEALTH NET with timely notification of any urgent emergent admission of any AIDS Member who is receiving anti-viral home treatments or of any AIDS Member who is receiving total parenteral nutrition. For purposes of this paragraph timely notification is within twenty-four (24) hours of an admission or the initial treatment. In the event PPG fails to notify HEALTH NET as set forth in this paragraph. AIDS related claims for such Members shall not be eligible for payment under this Program.