Annual Disclosures Sample Clauses

Annual Disclosures. On the Agreement anniversary date, PacifiCare shall disclose to Medical Group the following information for each and every type of risk arrangement (traditional commercial, point of service, small group, and individual plans), other than the Secure Horizons Health Plan, which may be covered by the Agreement: (a) A matrix of responsibility for medical expenses (physician, institutional, ancillary, and pharmacy) which will be allocated to Medical Group, a facility or PacifiCare under the Agreement; (b) Expected/projected utilization rates and unit costs for each major expense service group (inpatient, outpatient, primary care physician, specialist, pharmacy, home health, durable medical equipment, ambulance, and other), as well as the source of the data and the actuarial methods employed in determining the utilization rates and unit costs by benefit plan type. (c) All factors used to adjust payments or risk-sharing targets, including but not limited to the following: age, sex, localized geographic area, family size, experience rated, and benefit plan design, including copayment/deductible levels; (d) The amount of payment for each and every service to be provided under the contract, including any fee schedules or other factors or units used in determining the fees for each and every service. To the extent that reimbursement is made pursuant to a specified fee schedule, the Agreement shall incorporate the fee schedule by reference, and shall further specify the Medicare RBRVS year if RBRVS is the methodology used for the fee schedule development. For any proprietary fee schedule, the Agreement shall include sufficient detail that payment amounts related to that fee schedule can be accurately predicted. (e) In the case of Capitated Payment, PacifiCare shall disclose the amount to be paid per Member per month and shall provide details sufficient to allow Medical Group to verify the accuracy and appropriateness of any deductions from Capitation Payments.