Common use of Shared Savings Programs Clause in Contracts

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.

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 , the provisions of the Pharmacy Shared Savings Fund Program are set forth in Part C. 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 or incentive 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 HI , 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.

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. 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 or incentive 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.

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 or incentive 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.