Common use of Shared Risk Reinsurance Clause in Contracts

Shared Risk Reinsurance. PPG shall participate in the POS Shared Risk Reinsurance Program. The cost to the PPG for the POS Shared Risk Reinsurance Program shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: 0.75% % of applicable Medicare POS Member’s HCFA payment and county premium, if any. Out-of-Area Emergency and Urgently Needed Services are reimbursed at *** cent *** of cost, and the remaining *** of the cost shall be charged against the POS Shared Risk Budget. (b) In-Network and Out-of-Network POS Shared Risk Services: 0.04 % of applicable Medicare POS Member’s HCFA payment and county premium, if any. The cost of In-Network and Out-of-Network POS Shared Risk Services during the Reconciliation Period shall be charged against the POS Shared Risk Budget as follows: *** of any amount over ***.

Shared Risk Reinsurance. PPG shall participate in the POS Shared Risk Reinsurance Program. The cost to the PPG for the POS Shared Risk Reinsurance Program shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: 0.75% % *** of applicable Medicare POS Member’s HCFA payment and county premium, if any. Out-of-Area Emergency and Urgently Needed Services are reimbursed at *** cent *** eighty percent (80%) of cost, and the remaining *** twenty percent (20%.) of the cost shall be charged against the POS Shared Risk Budget. (b) In-Network and Out-of-Network POS Shared Risk Services: 0.04 0.34% of applicable Medicare POS Member’s HCFA payment and county premium, if any. The cost of In-Network and Out-of-Network POS Shared Risk Services during the Reconciliation Period shall be charged against the POS Shared Risk Budget as follows: *** of any amount over ***.

Shared Risk Reinsurance. PPG shall participate in the POS Shared Risk Reinsurance Program. The cost to the PPG for the POS Shared Risk Reinsurance Program shall be calculated as follows: (a) Out-of-Area Emergency and Urgently Needed Services: 0.75% % *** of applicable Medicare POS Member’s HCFA payment and county premium, if any. Out-of-Area Emergency and Urgently Needed Services are reimbursed at *** cent *** of cost, and the remaining *** twenty percent (20%) of the cost shall be charged against the POS Shared Risk Budget. (b) In-Network and Out-of-Network POS Shared Risk Services: 0.04 *** % of applicable Medicare POS Member’s HCFA payment and county premium, if any. The cost of In-Network and Out-of-Network POS Shared Risk Services during the Reconciliation Period shall be charged against the POS Shared Risk Budget as follows: *** of any amount over ***.