Common use of Reinsurance Program Clause in Contracts

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.