Medical Loss Ratio Adjustment Sample Clauses

Medical Loss Ratio Adjustment. Annually on a state fiscal year basis, the total annual Capitation Payment made to the Contractor for the combined ACA and Non-ACA populations and their associated healthcare costs shall be evaluated against a ninety (90) percent Minimum Medical Loss Ratio (MLR) Requirement to determine whether a Payment Adjustment is warranted (determined pursuant to Appendix E “Medical Loss Ratio Calculation.” A Payment Adjustment (premium refund) shall occur if:
Sample 1Sample 2Sample 3See All (5)
AutoNDA by SimpleDocs
Medical Loss Ratio Adjustment. For State Fiscal Year 2016, the total annual capitation payment made to the Contractor for Non-ACA Expansion Members and their associated healthcare costs shall be evaluated against an eighty-five (85) percent Minimum Medical Loss Ratio Requirement to determine whether a Payment Adjustment is warranted. If the Contractor has a Medical Loss Ratio of less than 85% (determined pursuant to Appendix B “Medical Loss Ratio Calculation,”) the Contractor shall submit a premium refund to the Commonwealth. The adjustment will be computed as eighty
Sample 1Sample 2
Medical Loss Ratio Adjustment. For State Fiscal Year 2016, the total annual capitation payment made to the Contractor for Non-ACA Expansion Members and their associated healthcare costs shall be evaluated against an eighty-five (85) percent Minimum Medical Loss Ratio Requirement to determine whether a Payment Adjustment is warranted. If the Contractor has a Medical Loss Ratio of less than 85 percent (determined pursuant to Appendix B “Medical Loss Ratio Calculation,”) the Contractor shall submit a premium refund to the Commonwealth. The adjustment will be computed as eighty (80) percent of the difference between the actual countable Non-ACA Expansion Medical Expenses of the Contractor and the 85% MLR requirement. Beginning with State Fiscal Year 2017 and continuing annually on a state fiscal year basis thereafter, the Contractor shall be required to expend at a minimum ninety (90) percent of Net Capitation Payments for the combined ACA and Non- ACA populations on Allowed Medical Expenses. A Payment Adjustment (premium refund) shall occur if:
Sample 1Sample 2
Medical Loss Ratio Adjustment. AnnuallyInBeginning with State Fiscal Year 20201 and continuing annually on a state fiscal year basis thereafter, the total annual Capitation Payment made to the Contractor shall calculate/report a MLR consistent with 42 CFR 438.8 for the combined ACA and Non-ACAMedicaid populations and their associated healthcare costs shall be evaluated against a ninety (90) percent Minimumcovered under the managed care contract. The MLR reporting process willith begin ten (10) months after the end of each State Fiscal Year. If the Contract with the Contractor is not renewed at any time or is terminated at any time, the Medical Loss Ratio (MLR) Requirementand Annual Statement will reflect an appropriately reduced number of months of experience instead of the full twelve (12) months. The MLR information shall be conveyed from the Contractor to the Commonwealth through an MLR Reporting Template developed by the Commonwealth. An actuary and an officer of the company shall attest to the accuracy of the MLR calculation and the information reported in the MLR Reporting Template. The MLR Reporting Template, and any other information the Contractor wants to submit for consideration, shall be due to the Commonwealth no later than twelve (12) months after the end of the reporting period. The Commonwealth shall then determine, within thirty (30) days of receipt of all information from all Contractors if any remittance is to be collected and notify the Contractor in writing. The Contractor shall then have fifteen (15) days to review the Commonwealth’s findings and remit payment to the Commonwealth. The Contractor shall cooperate with the Department or its contractor by supplying all clarifications and answers to inquiries within the requested timeframe. whether If the Contractor fails to submit information or respond to a Payment Adjustment is warranted (determined pursuant to Appendix E “Medical Loss Ratio Calculation.”Department request regarding the MLR calculation within the requested timeframe, it shall be subject to a penalty of $500.00 per day until the information or response is received. The MLR calculation for each MCO shall be the ratio of the numerator (42 CFR 438.8(e)) to the denominator (42 CFR 438.8(f)), A Payment Adjustment (premium refund)remittance from the MCO to the State shall occur if: the MLR is less than ninety (90) percent. The remittance amount shall be calculated as follows: The
Sample 1

Related to Medical Loss Ratio Adjustment

  • How Do I Correct an Excess Contribution? If you make a contribution in excess of your allowable maximum, you may correct the excess contribution and avoid the 6% penalty tax for that year by withdrawing the excess contribution and its earnings on or before the date, including extensions, for filing your tax return for the tax year for which the contribution was made (generally October 15th). Any earnings on the withdrawn excess contribution may also be subject to the 10% early distribution penalty tax if you are under age 59½. In addition, although you will still owe penalty taxes for one or more years, excess contributions may be withdrawn after the time for filing your tax return. Excess contributions for one year may be carried forward and applied against the contribution limitation in succeeding years. An individual who is partially or entirely ineligible to make contributions to a Xxxx XXX may transfer amounts of up to the yearly contribution limits to a non-deductible Traditional IRA (subject to reduction for amounts remaining in the Xxxx XXX plus other Traditional IRA contributions).

  • Wage Adjustment Notwithstanding any provision in this Agreement on the contrary, the wages of employees shall be reduced by the amount of employee contributions made by the employer pursuant to the provisions hereof.

  • Rate Redetermination after Catastro- phic Damage In event of Catastrophic Damage and ad- justment, if any, of Included Timber, Contracting Officer shall make an appraisal to determine for each species the catastrophe-caused difference between the appraised unit value of Included Timber remaining immediately prior to the catastrophe and the appraised unit value of existing and potential Included Timber immediately after the ca- tastrophe. Included Timber is any that would not be elimi- nated under B8.32. Potential Included Timber is any that would be added under B8.32. Tentative Rates and Flat Rates in effect at the time of catastrophe shall be adjusted by said differences to be- come the redetermined rates for the purpose of a contract modification under B8.32. Accordingly, Base Rates shall be adjusted to correspond to the redetermined rates if redetermined rates are less than the original Base Rates, subject to new Base Rate limitations of 25 cents per hun- dred cubic feet or equivalent. However, existing Base In- dices shall not be changed under this Subsection. Upon agreement under B8.32, redetermined rates and Required Deposits shall be considered established under B3.1 for timber Scaled subsequent to Catastrophic Damage. At time of such appraisal, Specified Road construc- tion cost shall include the estimated cost of any construc- tion work listed in the Schedule of Items performed and abandoned.

  • Reallocation to a Class with a Lower Salary Range Maximum 1. If the employee meets the skills and abilities requirements of the position and chooses to remain in the reallocated position, the employee retains existing appointment status and has the right to be placed on the Employer’s internal layoff list for the classification occupied prior to the reallocation.

  • Supervisory Differential Adjustment 99. The Appointing Officer may adjust the compensation of a supervisory employee whose schedule of compensation is set herein subject to the following conditions:

  • Compensate us for loss damage You will compensate us and hold us harmless against any loss, damage, liability, cost and expense (including legal costs) which we may reasonably incur or suffer as a result of or in connection with your card account and/ or this agreement, including without prejudice to the generality of the foregoing:-

  • Loss of Shared-Loss Coverage on Shared-Loss Loans The Receiver shall be relieved of its obligations with respect to a Shared-Loss Loan upon payment of a Foreclosure Loss amount, or a Short Sale Loss amount with respect to such Single Family Shared-Loss Loan, or upon the sale without FDIC consent of a Single Family Shared-Loss Loan by Assuming Institution to a person or entity that is not an Affiliate. The Assuming Institution shall provide the Receiver with timely notice of any such sale. Failure to administer any Shared-Loss Loan or Loans in accordance with Article III shall at the discretion of the Receiver constitute grounds for the loss of shared loss coverage with respect to such Shared-Loss Loan or Loans. Notwithstanding the foregoing, a sale of the Single Family Shared-Loss Loan, for purposes of this Section 2.7, shall not be deemed to have occurred as the result of (i) any change in the ownership or control of Assuming Institution or the transfer of any or all of the Single Family Shared-Loss Loan(s) to any Affiliate of Assuming Institution, (ii) a merger by Assuming Institution with or into any other entity, or (iii) a sale by Assuming Institution of all or substantially all of its assets.

  • Indemnity Limitation for TIPS Sales Texas and other jurisdictions restrict the ability of governmental entities to indemnify others. Vendor agrees that if any "Indemnity" provision which requires the TIPS Member to indemnify Vendor is included in any TIPS sales agreement/contract between Vendor and a TIPS Member, that clause must either be stricken or qualified by including that such indemnity is only permitted, "to the extent permitted by the laws and constitution of [TIPS Member's State]” unless the TIPS Member expressly agrees otherwise. Any TIPS Sale Supplemental Agreement containing an "Indemnity" clause that conflicts with these terms is rendered void and unenforceable.

  • Medical/Dental Expense Account The Employer agrees to allow insurance eligible employees to participate in a medical and dental expense reimbursement program to cover co- payments, deductibles and other medical and dental expenses or expenses for services not covered by health or dental insurance on a pre-tax basis as permitted by law or regulation, up to the maximum amount of salary reduction contributions allowed per calendar year under Section 125 of the Internal Revenue Code or other applicable federal law.

  • Contribution Formula Dental Coverage a. Faculty Member Coverage. For faculty member dental coverage, the Employer contributes an amount equal to the lesser of ninety percent (90%) of the faculty member premium of the State Dental Plan, or the actual faculty member premium of the dental plan chosen by the faculty member. However, for calendar years beginning January 1, 2014, and January 1, 2015, the minimum employee contribution shall be five dollars ($5.00) per month.

Time is Money Join Law Insider Premium to draft better contracts faster.