SHARED SAVINGS PROGRAM. As of the Effective Date the Medical and Hospital Service Contract is amended to include the following: Shared Savings Incentive Program. This Contract is eligible for the Shared Savings Incentive Program per Section 641.31076, F.S. This voluntary program allows Members to participate in the savings generated from Shoppable Health Care Services located at providers on the AvMed’s shared savings list. o AvMed’s shared savings list is available at xxx.xxxxx.xxx/xxxxxxxxxxxx. This list includes all available Shoppable Health Care Services and their Shared Savings Incentive amount. Be aware, this list may change. Please check frequently to ensure you have accurate information. o When you qualify for a reward, your Shared Saving Incentive will be sent to you by check approximately 30 days after we confirm that you received care at an incentive eligible location. o AvMed must notify you, and the Office of Insurance Regulation, at least 30 days before termination of this program Shared Savings Incentive means a voluntary and optional financial incentive that a health insurer may provide to an insured for choosing certain Shoppable Health Care Services under a Shared Savings Incentive Program.
SHARED SAVINGS PROGRAM. For the service fee specified in Exhibit A, we may make our Shared Savings Program available to some or all of your Plan, when such discounts are available to us. The program provides access to discounted charges from health care providers which are made available to us for use with the Subscriber benefit plans that we administer on behalf of our customers. The amount of benefits payable under the portion of the Plan to which the discounts apply will be determined based on the discounted charges under the program. If a Participant is enrolled in a network plan and receives services from a network provider under the terms of that plan, then health benefits payable for services rendered by that provider will be based on the applicable rates for fees for services set forth in our provider agreement with that provider rather than based on the discounts available under the Shared Savings Program. In this case, those benefits will not be included in the calculation of the “Savings Obtained” under the Shared Savings Program and the service fee for the Shared Savings Program will not apply to those benefits. Listings of providers subject to the discounts under this program will not be provided to you or to Participants. You understand that the services provided under the program are to provide access to provider discounts only. Our services under this program do not include credentialing of providers or other managed care network services. We can terminate the Shared Savings Program in whole or in part at any time for any reason. You can terminate the program at any time for any reason by giving us written notice. We will implement the termination within a reasonable period of time after receiving the notice.
SHARED SAVINGS PROGRAM. 19 SECTION 5.14 Agreement Not to Compete........................ 20
SHARED SAVINGS PROGRAM. Seller, directly or through ------------------------------------- an appropriate affiliate, agrees in good faith to continue the current Shared Savings Program ("SSP") business utilizing the services and products of the Company, subject to the fee arrangement established by Seller and Company. This fee arrangement consists of a fee equaling XX% of savings for claims accessing a Company discount through any of the Company's direct contracts or any of the Company's leased affiliate contracts, except for the Multiplan, Inc. network. For claims accessing a discount through the Company's agreement with Multiplan, the fee will be calculated as the prevailing Multiplan rate to the Company plus X percentage points. If the rate between Multiplan and the Company is renegotiated, Seller's rate with the Company would automatically be adjusted to reflect that change. Seller would participate on a prorata share in any retroactive rate credits given by Multiplan to the Company.
SHARED SAVINGS PROGRAM. Application of the Shared Savings Program provides additional savings on select non-Network facility and physician claims not eligible for standard network discounts. Program provides access to discounted charges made available to United from health care providers who contract or will negotiate with, a third party to provide such discounted charges. The services under this program provide access to provider discounts only and do not include credentialing of providers or other Network services. United is not responsible for the medical outcomes or the quality or competence of any provider or facility rendering services under the Shared Savings Program. Either party can terminate the Shared Savings Program at any time for any reason with written notice. Service Comments Facility Reasonable & Customary Charge Determination United can terminate the program in whole or in part at any Program. time for any reason This program provides for reduction of facility billed charges in accordance with appropriate guidelines. Access to Extended Networks (leased networks) Available at an additional charge. I. C ARE M AN AG EM EN T A ND O U T REAC H S E RVICE S Service Comments Personal Health Support, an integrated personal health Coordination with external vendors is subject to an additional management program using a designated team of nurses and fee. incorporating elements of care management core activities such as case management and support around specific treatment decisions. A pregnancy program, consumer engagement notification program including gaps in care messaging, and a predictive model specific to Customer are also included. Medical policy functions, as guided by a medical director. Standard on all managed plans. Disease Management Programs (including asthma, Coordination with external vendors is subject to an additional coronary artery disease, congestive heart failure and diabetes) fee. Complex Medical Conditions: • Cancer Resource Services • Congenital Heart Disease Resource Services • Healthy Pregnancy • Kidney Resource Services • Neonatal Resource Services Alternate Care Proposals (ACP) which provide appropriate and cost effective health care services and supplies alternatives that would otherwise not be covered by the Plan. Activation programs to engage Participants including, monthly health statements member call services, and access to member portal with consumer messaging Predictive modeling, using data from a proprietary system, to identify individu...
