Shared Savings Programs Sample Clauses

Shared Savings Programs. (a) Blue Shield shall establish a Shared Savings Program pursuant to which Blue Shield and Group share savings for the cost of Covered Shared Savings Services provided to Members during the Agreement Year. The provisions of the Shared Savings Program for Members who are enrolled in Benefit Programs other than Blue Shield 65 Plus are set forth in Part A of Exhibit D. The provisions of the Shared Savings Program for Blue Shield 65 Plus Members are set forth in Part B of Exhibit D. (b) Blue Shield shall establish a Pharmacy Shared Savings Fund Program pursuant to which Blue Shield and Group share savings for the cost of Covered Outpatient Prescription Drug services provided to Blue Shield 65 Plus Members during the Agreement Year. The provisions of the Pharmacy Shared Savings Fund Program are set forth in Part C. of Exhibit D. (c) Blue Shield may offset any amount owed to Blue Shield by Group under a Shared Savings Program, Pharmacy Shared Savings Fund, or other risk sharing agreement (regardless of year owed or under which agreement owed) from any amount, other than Capitation and Professional Stop Loss Program payments made pursuant to Exhibit H, owed by Blue Shield to Group under this or any other agreement between Blue Shield and Group. (d) In the event that Group has contracted with a provider for services at rates which are more favorable than the rates obtained by Blue Shield and a Shared Savings Service is provided by such provider to a Member hereunder, Group shall make best efforts to cooperate with Blue Shield to obtain such more favorable rate for the provision of such Shared Savings Service to such Member. (e) In the event Group wishes to dispute Blue Shield determinations regarding the Shared Savings Program settlements, it shall notify Blue Shield in writing within sixty (60) days following such settlement determination, and if such dispute is not resolved by the parties, Group may request arbitration as set forth in Article XI.
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Shared Savings Programs. Commercial and Medicaid. The state also has implemented an advanced primary care practice delivery system reform program. The design of these programs requires sampling, data collection and reporting of patient experience. This contract is for those services. Specifically, the Contractor shall work with the State on the administration of the (Consumer Assessment of Healthcare Providers and Systems) CAHPS® survey to measure patient experience, in support of Vermont’s assessment of the impact of a range of payment and delivery system reforms on the quality of primary care.
Sample 1
Shared Savings Programs. BCBSM has implemented programs to enhance the savings realized by its customers. As stated below, BCBSM will retain as administrative compensation a percent of the recoveries or cost avoidance. Administrative compensation retained by BCBSM through the Shared Savings Program will be available through reports obtained on eBookshelf: A. Pre-Payment Forensic Billing Review 30% Cost avoidance of improper hospital billing identified by third party vendor(s) through forensic pre-payment billing review. B. Advanced Payment Analytics 30% Recoveries of claims overpayments identified by third party vendor(s) using proprietary data mining analytics and enhanced reviews. C. Subrogation 30% Recoveries of claims overpayments from subrogation efforts. D. Provider Credit Balance Recovery 30% Recoveries of claims overpayments obtained by third party vendor(s) through enhanced review of hospital patient accounting systems. E. Non-Participating Provider Negotiated Pricing 30% Cost avoidance for out-of-network, non-participating Claims equal to the difference between the amount that would have been paid pursuant to the Group’s benefit design (before Enrollee cost-share is applied) and the amount actually paid for such Claims (before Enrollee cost-share is applied) as a result of third-party vendor negotiations or benchmark- based pricing. F. Rebate Service Fee for Medical Prescription Drugs 10% Medical benefit drug rebates on Claims incurred in the renewal term net of the Rebate Administrator Fee. The Rebate Administrator Fee is 5.25% of gross rebates for medical benefit drug Claims. G. Rebate Service Fee for Pharmacy Prescription Drugs -- Not Applicable
Sample 1

Related to Shared Savings Programs

  • Health Care Savings Plan As provided in this Agreement, eligible ASF Members will participate in the health care savings plan (HCSP) established under Minnesota Statute 352.98, and as administered by the Plan Administrator. The Employer is responsible only for transferring funds, as specified in this agreement, to the Plan Administrator. Subd. 1. All ASF Members who receive severance pay as defined in Section A of this article must participate in the health care savings plan. Subd. 2. All severance pay as defined in Section B of this article shall be transferred to the severed employee's health care savings plan account. At the time of separation, if an ASF Member has an approved exception to participation in the health care savings plan account from the plan administrator, then the ASF Member shall receive this payment in one lump sum payment of cash.

  • Incentive, Savings and Retirement Plans During the Employment Period, the Executive shall be entitled to participate in all incentive, savings and retirement plans, practices, policies and programs applicable generally to other peer executives of the Company and its affiliated companies, but in no event shall such plans, practices, policies and programs provide the Executive with incentive opportunities (measured with respect to both regular and special incentive opportunities, to the extent, if any, that such distinction is applicable), savings opportunities and retirement benefit opportunities, in each case, less favorable, in the aggregate, than the most favorable of those provided by the Company and its affiliated companies for the Executive under such plans, practices, policies and programs as in effect at any time during the 120-day period immediately preceding the Effective Date or if more favorable to the Executive, those provided generally at any time after the Effective Date to other peer executives of the Company and its affiliated companies.

  • Savings Plans Employee shall be entitled to participate in Employer’s 401(k) plan, or other retirement or savings plans as are made available to Employer’s other executives and officers and on the same terms which are available to Employer’s other executives and officers.

  • Profit Sharing Plan Under the Northrim BanCorp, Inc. Profit Sharing Plan (the “Plan”), Executive shall be eligible to receive an annual profit share based on performance as defined by the Board of Directors. Executive will be classified in the Executive tier under the Plan’s Responsibility Factors. If Employer is required to prepare an accounting restatement due to “material noncompliance of the Employer,” the Employer will recover from the Executive any incentive compensation during the three (3) years prior to the date of the restatement, in excess of what would have been paid under the restatement. Executive’s signature on this Agreement authorizes Employer to offset or deduct from any compensation Employer may owe Executive, any excess payments (in whole or in part) that Executive may owe Employer due to such restatement(s).

  • Retirement Savings Plan Within fifteen (15) days after the date of Termination of Employment, the Company shall pay to Employee a cash payment in an amount, if any, necessary to compensate Employee for the Employee’s unvested interests under the Company’s retirement savings plan which are forfeited by Employee in connection with the Termination of Employment.

  • Retirement Plans (a) In connection with the individual retirement accounts, simplified employee pension plans, rollover individual retirement plans, educational IRAs and XXXX individual retirement accounts (“XXX Plans”), 403(b) Plans and money purchase and profit sharing plans (“Qualified Plans”) (collectively, the “Retirement Plans”) within the meaning of Section 408 of the Internal Revenue Code of 1986, as amended (the “Code”) sponsored by a Fund for which contributions of the Fund’s shareholders (the “Participants”) are invested solely in Shares of the Fund, Transfer Agent shall provide the following administrative services: (i) Establish a record of types and reasons for distributions (i.e., attainment of eligible withdrawal age, disability, death, return of excess contributions, etc.); (ii) Record method of distribution requested and/or made; (iii) Receive and process designation of beneficiary forms requests; (iv) Examine and process requests for direct transfers between custodians/trustees, transfer and pay over to the successor assets in the account and records pertaining thereto as requested; (v) Prepare any annual reports or returns required to be prepared and/or filed by a custodian of a Retirement Plan, including, but not limited to, an annual fair market value report, Forms 1099R and 5498; and file same with the IRS and provide same to Participant/Beneficiary, as applicable; and (vi) Perform applicable federal withholding and send Participants/Beneficiaries an annual TEFRA notice regarding required federal tax withholding. (b) Transfer Agent shall arrange for PFPC Trust Company to serve as custodian for the Retirement Plans sponsored by a Fund. (c) With respect to the Retirement Plans, Transfer Agent shall provide each Fund with the associated Retirement Plan documents for use by the Fund and Transfer Agent shall be responsible for the maintenance of such documents in compliance with all applicable provisions of the Code and the regulations promulgated thereunder.

  • Savings Plan Executive will be eligible to enroll and participate, and be immediately vested in, all Company savings and retirement plans, including any 401(k) plans, as are available from time to time to other key executive employees.

  • Educator Plans General A) Educator Plans shall be designed to provide Educators with feedback for improvement, professional growth, and leadership; and to ensure Educator effectiveness and overall system accountability. The Plan must be aligned to the standards and indicators and be consistent with district and school goals. B) The Educator Plan shall include, but is not limited to: i) At least one goal related to improvement of practice tied to one or more Performance Standards; ii) At least one goal for the improvement the learning, growth and achievement of the students under the Educator’s responsibility; iii) An outline of actions the Educator must take to attain the goals and benchmarks to assess progress. Actions must include specified professional development and learning activities that the Educator will participate in as a means of obtaining the goals, as well as other support that may be suggested by the Evaluator or provided by the school or district. Examples may include but are not limited to coursework, self-study, action research, curriculum development, study groups with peers, and implementing new programs. C) It is the Educator’s responsibility to attain the goals in the Plan and to participate in any trainings and professional development provided through the state, district, or other providers in accordance with the Educator Plan.

  • In-Service Programs The parties to this collective agreement recognize the value of in-service education both to the employee and the Employer. A) The Employer reserves the right to identify specific in-service programs deemed compulsory. B) Employees required to attend such programs will be paid at the applicable rate of pay.

  • Distribution Plans You shall also be entitled to compensation for your services as provided in any Distribution Plan adopted as to any series and class of any Fund’s Shares pursuant to Rule 12b-1 under the 1940 Act. The compensation provided in any such Distribution Plan (a “12b-1 Plan”) may be divided into a distribution fee and a service fee, as set forth in such Plan and the Fund’s then current prospectus and statement of additional information (“SAI”), each of which is compensation for different services to be rendered to the Fund. Subject to the termination provisions in a 12b-1 Plan, any distribution fee with respect to the sale of a Share subject to such Plan shall be earned when such Share is sold and shall be payable from time to time as provided in the 12b-1 Plan. The distribution fee payable to you as provided in any 12b-1 Plan shall be payable without offset, defense or counterclaim (it being understood by the parties hereto that nothing in this sentence shall be deemed a waiver by the Fund of any claim the Fund may have against you).

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