Common use of Shared Risk Reinsurance Clause in Contracts

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance program. The cost to the PPG for the Shared Risk Reinsurance program shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed services: *** of the applicable Medicare HMO Member’s HCFA payment and county premium, if any. Out-of-Area Emergency and Urgently Needed services are reimbursed at *** of cost, and the remaining *** of the cost shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk services: 0.06 % of the applicable Medicare HMO Member’s HCFA payment and county premium, if any. The cost of in-area Shared Risk services utilized by a Medicare HMO Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** any amount over ***.

Shared Risk Reinsurance. PPG shall participate in the Shared Risk Reinsurance program. The cost to the PPG for the Shared Risk Reinsurance program shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed services: *** 1.5 % of the applicable Medicare HMO Member’s HCFA payment and county premium, if any. Out-of-Area Emergency and Urgently Needed services are reimbursed at *** of cost, and the remaining *** of the cost shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk services: 0.06 % of the applicable Medicare HMO Member’s HCFA payment and county premium, if any. The cost of in-area Shared Risk services utilized by a Medicare HMO 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 the PPG for the Shared Risk Reinsurance program shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed services: *** of the applicable Medicare HMO Member’s HCFA payment and county premium, if any. Out-of-Area Emergency and Urgently Needed services Services are reimbursed at *** of cost, and the remaining *** of the cost shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk services: services 0.06 % of the applicable Medicare HMO Member’s HCFA payment and county premium, if any. The cost of in-area Shared Risk services utilized by a Medicare HMO 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 the PPG for the Shared Risk Reinsurance program shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed services: *** of the applicable Medicare HMO Member’s HCFA payment and county premium, if any. Out-of-Area Emergency and Urgently Needed services are reimbursed at *** of cost, and the remaining *** of the cost shall be charged against the Shared Risk Budget. (b) In-Area Shared Risk services: 0.06 *** % of the applicable Medicare HMO Member’s HCFA payment and county premium, if any. any The cost of in-area Shared Risk services utilized by a Medicare HMO Member in a Reconciliation Period shall be charged against the Shared Risk Budget as follows: *** of any amount over ***.