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: A. The Contractor has a MLR of less than ninety percent (90%) but greater than or equal to eighty-six percent (86%). The Contractor shall submit a Payment Adjustment (premium refund) to the Commonwealth for seventy-five percent (75%) of the difference between the dollar amount corresponding to actual MLR and the dollar amount corresponding to a ninety percent (90%) Medical Loss Ratio. B. The Contractor has a MLR less than eighty six percent (86%). The Contractor shall submit a Payment Adjustment (premium refund) to the Commonwealth for the sum of: (a) seventy-five percent (75%) of the difference between the dollar amount corresponding to an eighty six percent (86%) MLR and the dollar amount corresponding to a ninety percent (90%) MLR; and
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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: A. The Contractor has a Medical Loss Ratio of less than 90 percent but greater than or equal to eighty-six (86) percent. The Contractor shall submit a Payment Adjustment (premium refund) to the Commonwealth for seventy-five (75) percent of the difference between the dollar amount corresponding to actual medical loss ratio and the dollar amount corresponding to an 90 percent Medical Loss Ratio. B. The Contractor has a Medical Loss Ratio less than 86 percent. The Contractor shall submit a Payment Adjustment (premium refund) to the Commonwealth for the sum of: (a) 75 percent of the difference between the dollar amount corresponding to an 86 percent medical loss ratio and the dollar amount corresponding to an 90 percent loss ratio; and (b) one hundred (100) percent of the difference between the actual countable medical expenses for the Contractor and the dollar amount corresponding to an 86 percent medical loss ratio. The adjustment process will begin 12 months after the end of each State Fiscal Year. If the contract with the Contractor is not renewed at any time on the July 1st annual contract renewal date or is terminated at any time, the Medical Loss Ratio and Annual Statement will reflect an appropriately reduced number of months of experience instead of the full 12 months. As part of the financial reconciliation process described above, the Contractor will be required to prepare and certify supplemental financial schedules to reconcile Medical Expe...
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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
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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 The A. If the Contractor has a MLR of less than ninety percent (90%) but greater than or equal to eighty-six...
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Related to Medical Loss Ratio Adjustment

  • PREMIUM ADJUSTMENT If THE COMPANY overpays a reinsurance premium and THE REINSURER accepts the overpayment, THE REINSURER’s acceptance will not constitute or create a reinsurance liability or increase in any existing reinsurance liability. Instead, THE REINSURER will be liable to THE COMPANY for a credit in the amount of the overpayment. If a reinsured policy terminates, THE REINSURER will refund the excess reinsurance premium. This refund will be on a prorated basis without interest from the date of termination of the policy to the date to which a reinsurance premium has been paid.

  • 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 under Section 4973 of the Internal Revenue Code for that year by withdrawing the excess contribution and its earnings on or before the due date, including extensions, of the tax return for the tax year for which the contribution was made (generally October 15th). Any earnings on the withdrawn excess contribution may be subject to a 10% early distribution penalty tax if you are under age 59½. In addition, in certain cases an excess contribution may be withdrawn after the time for filing your tax return. Finally, excess contributions for one year may be carried forward and applied against the contribution limitation in succeeding years.

  • Cash Flow Coverage Ratio The ratio of (a) the Borrower's Cash Flow to (b) the sum of (i) the Borrower's consolidated Interest Expense plus (ii) the Borrower's scheduled payments of principal (including the principal component of Capital Leases) to be paid during the 12 months following any date of determination shall at all times exceed (1) 1.5 to 1.

  • 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 the 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. 2. If the employee chooses to vacate the position or does not meet the skills and abilities requirements of the position, the layoff procedure specified in Article 31 of this Agreement applies.

  • Supervisory Differential Adjustment The Appointing Officer shall adjust the compensation of a supervisory employee whose compensation grade is set herein subject to the following conditions:

  • Section 754 Adjustment To the extent an adjustment to the adjusted tax basis of any Partnership asset pursuant to Code Section 734(b) or Code Section 743(b) is required, pursuant to Regulations Section 1.704-1(b)(2)(iv)(m)(2) or Regulations Section 1.704-1(b)(2)(iv)(m)(4), to be taken into account in determining Capital Accounts as the result of a distribution to a Holder in complete liquidation of his interest in the Partnership, the amount of such adjustment to the Capital Accounts shall be treated as an item of gain (if the adjustment increases the basis of the asset) or loss (if the adjustment decreases such basis) and such gain or loss shall be specially allocated to the Holders in accordance with their interests in the Partnership in the event that Regulations Section 1.704-1(b)(2)(iv)(m)(2) applies, or to the Holders to whom such distribution was made in the event that Regulations Section 1.704-1(b)(2)(iv)(m)(4) applies.

  • Minimum Consolidated Fixed Charge Coverage Ratio The Consolidated Fixed Charge Coverage Ratio shall not be less than 1.50 to 1.00, determined based on information for the most recent fiscal quarter annualized.

  • Net Loss A Net Loss for a particular fund or, in the case of a multi-class fund, a class results when aggregate Losses exceed aggregate Benefits (i.e., net redemptions on a day the fund’s or class’s NAV is overstated or net subscriptions on a day the fund’s or class’s NAV is understated) during the Error Period.

  • Year-End Adjustment If necessary, on or before the last day of the first month of each fiscal year, an adjustment payment shall be made by the appropriate party in order that the amount of the investment advisory fees waived or reduced and other payments remitted by the Adviser to the Fund or Funds with respect to the previous fiscal year shall equal the Excess Amount.

  • Minimum Interest Coverage Ratio The Borrowers shall not permit the Interest Coverage Ratio, calculated as of the end of each fiscal quarter for the four fiscal quarters then ended, to be less than 3.50 to 1.00.

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