Reinsurance Program. Claims under the Reinsurance Program shall be valued at the Cost of Care as defined in this Agreement. The Reinsurance Deductible, Reinsurance Premium and Reinsurance Coinsurance for the Commercial Plan shall initially be:
(i) Reinsurance Deductible shall be percent ( %) per Commercial Plan Member per calendar year.
(ii) Reinsurance Premium shall be percent ( %) of Commercial Plan Premium.
(iii) Reinsurance Coinsurance shall be fifty percent (50%) of the Cost of Care for amounts in excess of the Reinsurance Deductible but less than two hundred fifty thousand dollars ($250,000) and twenty percent (20%) of the Cost of Care for amounts in excess of two hundred fifty thousand dollars ($250,000).
Reinsurance Program. PacifiCare shall provide reinsurance protection (“Reinsurance Program”) in order to limit Medical Group’s financial risk for Hospital Services under the Commercial Hospital Incentive Program and Secure Horizons Hospital Incentive Program (the “Hospital Incentive Programs”), when administered by PacifiCare, and to limit POS Out-of-Network risk under the Commercial POS Control Program, to a specified dollar amount per Medical Group Member per calendar year (the “Reinsurance Deductible”), while encouraging Medical Group’s continuing involvement with Medical Group Member’s care by sharing a portion of the financial responsibility for Hospital Services which exceed the Reinsurance Deductible (“Reinsurance Coinsurance”). The Reinsurance Deductible and Reinsurance Coinsurance for Medical Group are specified in each Product Attachment. Notwithstanding any other provision of this Agreement, PacifiCare may amend the Reinsurance Deductible and Reinsurance Coinsurance on an annual basis effective at the beginning of any calendar year by providing sixty (60) calendar days’ prior written notice to Medical Group. For Hospital Services which exceed the Reinsurance Deductible, the Reinsurance Coinsurance shall be based on the Reinsurance Program as defined in the applicable Product Attachment, subject to the Medical Group’s compliance with the procedures set forth in the Provider Manual and the provisions set forth below.
Reinsurance Program. Claims under the POS Control Program Reinsurance shall be valued at one thousand five hundred dollars ($1,500) per acute inpatient day, four hundred dollars ($400) per skilled nursing facility day, and zero dollars ($0) for all other claims. The Reinsurance Deductible and Reinsurance Premium for the Commercial POS Plan shall initially be:
(i) Reinsurance Deductible shall be ( ) per Commercial Plan Member per calendar year.
(ii) In-Network Reinsurance Premium shall be ( ) of the Commercial Plan Reinsurance Premium amount set forth in Section 3.3.1 of Product Attachment A.
(iii) Out-of-Network Reinsurance Premium shall be ( ) of the Commercial Plan Reinsurance Premium amount set forth in Section 3.3.1
Reinsurance Program. Claims under the Reinsurance Program shall be valued at the Cost of Care as defined in this Agreement. The Reinsurance Deductible, Reinsurance Premium and Reinsurance Coinsurance for the Secure Horizons Plan shall initially be:
(i) Reinsurance Deductible shall be forty thousand dollars and no cents ($40,000) per Secure Horizons Member per calendar year.
(ii) Reinsurance Premium shall be nine and six tenths percent (9.06%) of the Secure Horizons Revenue.
(iii) Reinsurance Coinsurance shall be fifty percent (50%) of the Cost of Care for amounts in excess of the Reinsurance Deductible but less than two hundred fifty thousand dollars ($250,000) and twenty percent (20%) of the Cost of Care for amounts in excess of two hundred fifty thousand dollars ($250,000).
Reinsurance Program. Claims under the Reinsurance Program shall be valued at the Cost of Care as defined in this Agreement. The Reinsurance Deductible, Reinsurance Premium and Reinsurance Coinsurance for the Secure Horizons Plan shall initially be:
(i) Reinsurance Deductible shall be ( ) per Secure Horizons Member per calendar year.
(ii) Reinsurance Premium shall be percent ( %) of the Secure Horizons Revenue.
(iii) Reinsurance Coinsurance shall be *** of the Cost of Care for amounts in excess of the Reinsurance Deductible but less than *** and *** of the Cost of Care for amounts in excess of ***.
Reinsurance Program. Use commercially reasonable best efforts to establish within 90 days of the Closing Date, and thereafter provide evidence satisfactory to the Agent that the Blended Alternative Risk Transfer Insurance is in effect.
Reinsurance Program. Claims under the Reinsurance Program shall be valued at the Cost of Care as defined in this Agreement. The Reinsurance Deductible, Reinsurance Premium and Reinsurance Coinsurance for the Commercial Plan shall initially be:
(i) Reinsurance Deductible shall be *** per Commercial Plan Member per calendar year.
(ii) Reinsurance Premium shall be *** of Commercial Plan Premium.
(iii) Reinsurance Coinsurance shall be *** of the Cost of Care for amounts in excess of the Reinsurance Deductible but less than *** and *** of the Cost of Care for amounts in excess of ***
Reinsurance Program. Claims under the POS Control Program Reinsurance shall be valued at *** per acute inpatient day, *** per skilled nursing facility day, and *** for all other claims. The Reinsurance Deductible and Reinsurance Premium for the Commercial POS Plan shall initially be:
(i) Reinsurance Deductible shall be *** per Commercial Plan Member per calendar year.
(ii) In-Network Reinsurance Premium shall be *** of the Commercial Plan Reinsurance Premium amount set forth in Section 3.3.1 of Product Attachment A.
(iii) Out-of-Network Reinsurance Premium shall be seventy-seven hundredths percent (.77%) of the Commercial Plan Reinsurance Premium amount set forth in Section 3.3.1
Reinsurance Program. PacifiCare shall provide Reinsurance protection in order to limit Medical Group’s financial risk for Hospital Services under the Commercial Hospital Incentive Program and Secure Horizons Hospital Incentive Program (the “Hospital Incentive Programs”) to a specified dollar amount per Medical Group Member per calendar year (the “Reinsurance Deductible”), while encouraging Medical Group’s continuing involvement with Medical Group Member’s care by sharing a portion of the financial responsibility for Hospital Services which exceed the Reinsurance Deductible (“Reinsurance Coinsurance”). The Reinsurance Deductible and Reinsurance Coinsurance for Medical Group are specified in each Product Attachment. Notwithstanding any other provision of this Agreement, PacifiCare may amend the Reinsurance Deductible and Reinsurance Coinsurance on an annual basis effective at the beginning of any calendar year by providing sixty (60) calendar days prior written notice to Medical Group. For Hospital Services which exceed the Reinsurance Deductible, the Reinsurance Coinsurance shall be based on actual amounts paid by PacifiCare, subject to the Medical Group’s compliance with the procedures set forth in the Provider Manual and the provisions of this Section set forth below.
Reinsurance Program. Claims under the Reinsurance Program shall be valued as follows: $1,500 per acute inpatient day, $400 per Skilled Nursing Facility day; and $0 for all other claims under the program. The Reinsurance Deductible, Reinsurance Premium and Reinsurance Coinsurance for the Secure Horizons Plan shall initially be:
(i) Reinsurance Deductible shall be sixty thousand dollars ($60,000) per Secure Horizons Member per calendar year.
(ii) Reinsurance Premium shall be two and 10/100 percent (2.10%) of the Secure Horizons Revenue.
