Common use of Shared Risk Reinsurance Clause in Contracts

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** of Shared Risk Budget. The cost of In-Area Shared Risk Services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over ***.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) *** of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** % of Shared Risk Budget. The cost of Inin-Area area Shared Risk Services services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over *** up to *** and *** of any amount over ***.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** 3.75% of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) of allowed amount, and the remaining *** twenty percent (20%) shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** of Shared Risk Budget. The cost of Inin-Area area Shared Risk Services services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over *** up to *** and *** of any amount over ***.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) *** of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** of Shared Risk Budget. The cost of Inin-Area area Shared Risk Services services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over *** up to *.**; and *** any amount over ***

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) *** of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** *% of Shared Risk Budget. The cost of In-Area Shared Risk Services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** *% of any amount over $ ***.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** of Shared Risk Budget. The cost of In-Area Shared Risk Services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over ***$100,000.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** *% of Shared Risk Budget. Out-Out of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** of Shared Risk Budget. Budget The cost of Inin-Area area Shared Risk Services services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over *** up to ***: and *** amount over.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) *** of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** of Shared Risk Budget. The cost of In-Area Shared Risk Services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over ***.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) *** of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** of Shared Risk Budget. The cost of Inin-Area area Shared Risk Services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over ***.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** 3.75% of Shared Risk Budget. Out-of-of- Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) of allowed amount, and the remaining *** twenty percent (20%) shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** 2.3% of Shared Risk Risks Budget. The cost of Inin-Area area Shared Risk Services services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over *** up to *.**: and *** of any amount over ***

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** of Shared Risk Budget. The cost of Inin-Area area Shared Risk Services services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over ***.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) *** of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** of Shared Risk Budget. The cost of In-Area Shared Risk Services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over ***. (c) Transfer Reinsurance: *** PMPM, shall be deducted from the Shared Risk Budget. *** eligible charges shall be charged against the Shared Risk Budget.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** *% of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) of allowed amount, and the remaining *** *% shall be charged against the Shared Risk Budget. (b) In-In Area Shared Risk Services: *** *% of Shared Risk Budget. The cost of Inin-Area area Shared Risk Services services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over *** up to ***; and *** of any amount over ***.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *:*** of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: 1 *** of Shared Risk Budget. The cost of In-Area Shared Risk Services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over ***$ 100,000.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** 2.3 % of Shared Risk Budget. The cost of Inin-Area area Shared Risk Services services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over *** up to *** and *** of any amount over ***. (c) Transfer Reinsurance: *** PMPM, shall be deducted from the Shared Risk Budget. Ten ( 10%) of eligible charges shall be charged against the Shared Risk Budget.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** % of Shared Risk Budget. The cost of In-Area Shared Risk Services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over ***.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance Program. The cost to PPG for such participation shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: *** of Shared Risk Budget. Out-of-Area Emergency and Urgently Needed Services are reimbursed at eighty percent (80%) *** of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk Services: *** of Shared Risk Budget. The cost of In-Area Shared Risk Services utilized by a Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over ***.