Limit A. The Reinsurer agrees to indemnify the Reinsured for the Reinsurer's Share of the amount of the Reinsured's aggregate Ultimate Net Loss that is in excess of a Retention equal to 53% of Subject Earned Premium.
Limit A. For each year of the budget neutrality agreement an annual budget neutrality expenditure limit is calculated for each EG described as follows:
i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the Commonwealth under section X for each EG, including the hypothetical populations, times the appropriate estimated per member/per month (PMPM) costs from the table in subparagraph (v) below;
ii. Starting in SFY 2006, actual expenditures for the CommonHealth EG will be included in the expenditure limit for the Commonwealth. The amount of actual expenditures to be included will be the lower of the trended baseline CommonHealth costs, or actual CommonHealth per member per most cost experience for SFYs 2015- 2017;
iii. The amount of actual expenditures included will be the lower of the trended baseline costs, or actual per member per most cost experience for each eligibility group in SFYs 2015-2017;
iv. Historical PMPM costs used to calculate the budget neutrality expenditure limit in prior demonstration periods are provided in Attachment D; and
v. The PMPMs for each EG used to calculate the annual budget neutrality expenditure limit for this demonstration are specified below. Base Families 5.2 percent $655.57 $689.66 $725.53 $763.25 $802.94 Base Disabled 4.8 percent $1,442.34 $1,511.57 $1,584.13 $1,660.17 $1,739.86 BCCDP 5.3 percent $4,290.46 $4,517.85 $4,757.30 $5,009.44 $5,274.94 1902(r)2 Children 4.6 percent $526.70 $550.93 $576.27 $602.78 $630.51 1902(r)2 Disabled 4.8 percent $1,129.30 $1,183.51 $1,240.32 $1,299.85 $1,362.25 CommonHealth 4.8 percent $671.10 $711.36 $754.04 $799.29 $847.24
Limit A. For each year of the budget neutrality agreement an annual budget neutrality expenditure limit is calculated for each EG described as follows:
Limit A. For each year of the budget neutrality agreement an annual budget neutrality expenditure limit is calculated for each EG described as follows:
i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the Commonwealth under section X, paragraph 63 for each EG, including the four hypothetical populations, times the appropriate estimated per member per month (PMPM) costs from the table in subparagraph (v) below;
ii. Starting in SFY 2006, actual expenditures for the CommonHealth EG will be included in the expenditure limit for the Commonwealth. The amount of actual expenditures to be included will be the lower of the trended baseline CommonHealth costs, or actual CommonHealth per member per most cost experience for SFYs 2009- 2011;
iii. Starting in SFY 2009, actual expenditures for the CommCare-19-20, Essential-19-20 and CommCare Parents EGs will be included in the expenditure limit for the Commonwealth. The amount of actual expenditures to be included will be the lower of the trended baseline costs, or actual per member per most cost experience for these groups in SFYs 2009-2011; Demonstration Approval Period: December 22, 2008 through June 30, 2011 34 iv. Historical PMPM costs used to calculate the budget neutrality expenditure limit in prior Demonstration periods are provided in Attachment D; and
