MLR Rebate. The MCP shall be required to expend at minimum 85 percent of Net Capitation Payments for the Extension population on Allowed Medical Expenses. If the MCP does not meet the minimum 85 percent MLR threshold, then the MCP shall return to the State the difference between 85 percent of total Net Capitation Payments to the MCP and actual Allowed Medical Expenses incurred. After completion of the MLR calculation, if it is determined that the MLR of the MCP is less than 85 percent, then ODM will notify the MCP of the capitation payments to be returned to the State.
MLR Rebate. In the event INSURER achieves an MLR less than eighty-five percent (85%) for a Contract Year, INSURER shall return to FHKC one hundred percent (100%) of the difference between the MLR achieved and the minimum MLR of eighty-five percent (85%). INSURER’s MLR rebate shall include both INSURER’s Title XXI Enrollees and INSURER’s Full Pay Enrollees; however, INSURER shall report the portion of the rebate attributable to the Title XXI Enrollees and the Full Pay Enrollees based on the respective proportion of Enrollee member months for the Contract Year. The rebate is due to FHKC within fifteen (15) calendar days of notice to INSURER that FHKC has accepted the annual experience adjustment report. This provision is effective for each Contract Year beginning July 1, 2019, and includes any Contract Year fewer than twelve (12) months in length.
