Common use of Payment Obligations for Quality and Health Clause in Contracts

Payment Obligations for Quality and Health. Equity Performance a) Contractor is subject to potential payment obligations for quality and health equity performance requirements as specified in Attachment 2 — Performance Standards with Penalties and Attachment 4 — Quality Transformation Initiative. The maximum payment obligations collectively between these two begin at 1% of Contractor’s total Gross Premium per product for Plan Year 2023 and increase by an additional 1% of Contractor’s total Gross Premium per product per Plan Year up to 3% maximum over the contract period and up to 4% in future contract years. Potential payment obligations for quality performance will not exceed the following maximum amounts per Plan Year: i. For Measurement Year 2023: 1% of Contractor’s total Gross Premium per product for Plan Year 2023. ii. For Measurement Year 2024: 2% of Contractor’s total Gross Premium per product for Plan Year 2024. iii. For Measurement Year 2025: 3% of Contractor’s total Gross Premium per product for Plan Year 2025. iv. For Measurement Year 2026 and beyond: 4% of Contractor’s total Gross Premium per product for Plan Year 2026.

Payment Obligations for Quality and Health. Equity PerformancePerformance‌ a) Contractor is subject to potential payment obligations for quality and health equity performance requirements as specified in Attachment 2 — Performance Standards with Penalties and Attachment 4 — Quality Transformation Initiative. The maximum payment obligations collectively between these two begin at 1% of Contractor’s total Gross Premium per product for Plan Year 2023 and increase by an additional 1% of Contractor’s total Gross Premium per product per Plan Year up to 3% maximum over the contract period and up to 4% in future contract years. Potential payment obligations for quality performance will not exceed the following maximum amounts per Plan Year: i. For Measurement Year 2023: 1% of Contractor’s total Gross Premium per product for Plan Year 2023. ii. For Measurement Year 2024: 2% of Contractor’s total Gross Premium per product for Plan Year 2024. iii. For Measurement Year 2025: 3% of Contractor’s total Gross Premium per product for Plan Year 2025. iv. For Measurement Year 2026 and beyond: 4% of Contractor’s total Gross Premium per product for Plan Year 2026.