Common use of SUPPLEMENTAL BENEFITS COSTS Clause in Contracts

SUPPLEMENTAL BENEFITS COSTS. For purposes of calculating PPG’s Capitation, the specific amounts set forth below as a percent of the applicable HCFA payment and the county premium, if any, shall be withheld to cover the actual cost of supplemental benefits that are not PPG Capitated Services, and commissions and taxes, if any. Such supplemental benefits may include, but are not limited to, pharmacy, vision, and dental benefits. On an annual basis, these withheld amounts shall be revised, forwarded to PPG, and incorporated into this Agreement by reference. County Percent Alameda 5.71 % Butte 0.55 % Colusa 0.52 % Contra Costa 5.68 % El Dorado 5.22 % Fresno 5.11 % Xxxxx 0.57 % Xxxx 11.80 % Los Angeles 9.27 % Madera 4.90 % Marin 4.09 % Mariposa 5.42 % Napa 0.48 % Orange 10.03 % Placer 6.71 % Plumas 0.55 % Riverside 12.08 % Sacramento 6.01 % San Bernadino 11.57 % San Diego 11.27 % San Francisco 5.90 % San Xxxxxxx 7.03 % San Xxxx Obispo 11.37 % San Matco 7.16 % Santa Xxxxxxx 11.28 % Santa Xxxxx 6.68 % Sierra 0.58 % Xxxxxx 0.59 % Sonoma 5.28 % Stanislaus 7.09 % Sutter 0.57 % Tulare 4.91 % Ventura 11.81 % Yolo 5.35 % Yuba 0.55 % ADDENDUM C.2 PHARMACY SHARED RISK BUDGETS For purposes of calculating PPG’s Pharmacy Budget, the specific amounts set forth below as a percent of the applicable HCFA payment and the county premium, if any, are applicable. On an annual basis, these amounts shall be revised, forwarded to PPG, and incorporated into this Agreement by reference. County Percent Alameda 4.48 % Butte 0.00 % Colusa 0.00 % Contra Costa 4.45 % El Dorado 4.60 % Fresno 4.42 % Xxxxx 0.00 % Xxxx 10.35 % Los Angeles 8.14 % Madera 4.25 % Marin 3.58 % Mariposa 4.69 % Napa 0.00 % Orange 8.80 % Placer 5.26 % Plumas 0.00 % Riverside 11.51 % Sacramento 4.67 % San Bernadino 11.02 % San Diego 9.89 % San Francisco 4.62 % San Xxxxxxx 5.51 % San Xxxx Obispo 10.66 % San Mateo 5.61 % Santa Xxxxxxx 10.58 % Santa Xxxxx 5.24 % Sierra 0.00 % Xxxxxx 0.00 % Sonoma 4.70 % Stanislaus 5.55 % Sutter 0.00 % Tulare 4.25 % Ventura 11.25 % Yolo 4.71 % Yuba 0.00 % ADDENDUM C.3 DIVISION OF FINANCIAL RESPONSIBILITY MATRIX OF HMO AND PPG CAPITATED SERVICES MEDICARE BENEFIT PROGRAM The following matrix outlines the division of financial responsibility between FHS, PPG and Hospital. The matrix is intended only as a summary guide. The applicable Subscriber’s Certificate should be consulted for an accurate and complete description of Covered Services and the Provider Operations Manual for clarification. MATRIX EFFECTIVE 1/1/98 PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES AIDS - Facility Component *** *** *** AIDS - Professional Component *** *** *** AIDS - Drugs *** *** *** ALLERGY IMMUNOTHERAPY *** *** *** ALLERGY TESTING *** *** *** ALPHA-FETOPROTEIN *** *** *** AMBULANCE *** *** *** In Area (30 Mile Radius) *** *** *** Out-of-Area *** *** *** ANESTHESIOLOGY *** *** *** BIOFEEDBACK *** *** *** BLOOD/BLOOD PRODUCTS *** *** *** Blood Bank *** *** *** Autologous/Homologous *** *** *** Storage and Collection of Blood *** *** *** CHEMICAL DEPENDENCY *** *** *** • Inpatient Facility Component *** *** *** • Inpatient Professional Component *** *** *** • Outpatient Facility Component *** *** *** • Outpatient Professional Component *** *** *** CHEMOTHERAPY *** *** *** • Drugs, including Epogen, Napugen and adjunctive therapies *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** CHIROPRACTIC (Medicare Approved) *** *** *** COLOSTOMY SUPPLIES *** *** *** CONSULTATIONS *** *** *** COSMETIC SURGERY *** *** *** (Medically Necessary) *** *** *** Professional Component *** *** *** Facility Component *** *** *** CRITICAL CARE VISITS *** *** *** DENTAL SERVICES *** *** *** (When a covered benefit) *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** *** All references to the division of financial responsibility have been deleted. 77 PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES DIAGNOSTIC TESTING - Outpatient Facility & Professional *** *** *** DURABLE MEDICAL EQUIPMENT *** *** *** • Outpatient *** *** *** • Surgically Implanted *** *** *** EMERGENCY ADMISSIONS – In-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EMERGENCY ADMISSIONS - Out-of-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EMERGENCY ROOM VISITS - In-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EMERGENCY ROOM VISITS – Out-of-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EXTENDED CARE/SKILLED NURSING FACILITY *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** GROWTH HORMONES *** *** *** HEARING AIDS *** *** *** HEMODIALYSIS *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** • Epogen, Nupogen *** *** *** HEPATITIS-B *** *** *** HOME HEALTH *** *** *** HOME VISITS *** *** *** HOSPICE *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** HOSPITAL BASED PHYSICIANS – Inpatient, Ambulatory Surgery or Emergency Room *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** IMMUNIZATIONS *** *** *** *** *** *** INFANT APNEA MONITOR *** *** *** INJECTIBLES, SELF ADMINISTERED *** *** *** *** All references to the division of financial responsibility have been deleted. PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES INPATIENT VISITS *** *** *** IVF & GIFT *** *** *** Professional Component *** *** *** Facility Component *** *** *** LITHOTRIPSY *** *** *** Professional Component *** *** *** Facility Component *** *** *** MATERNITY - Deliveries and Non-Deliveries *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** MEDICAL ADMISSIONS *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** MENTAL HEALTH - Inpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** MENTAL HEALTH - Outpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** OFFICE VISITS *** *** *** PATIENT EDUCATION *** *** *** PATHOLOGY - Inpatient, Ambulatory Surgery or Emergency Room *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** PATHOLOGY - Office *** *** *** PATHOLOGY - Outpatient *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** PERIODIC EXAMS *** *** *** PRE ADMISSION - Outpatient *** *** *** Laboratory, X-ray *** *** *** (within 72 hrs. or related admission) *** *** *** PROSTHETIC/ORTHOTIC DEVICES *** *** *** • Outpatient *** *** *** • Surgically Implanted *** *** *** RADIOLOGY - Inpatient, Ambulatory Surgery or Emergency Room *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** RADIOLOGY - Office *** *** *** RADIOLOGY - Outpatient *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** SPEECH AND HEARING EXAMS *** *** *** *** All references to the division of financial responsibility have been deleted. PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES SUPPLIES- Medical, Surgical, Office *** *** *** • Related to an Outpatient Office Visit: Splints, Casts, Bandages, etc... *** *** *** • Related to a Hospital Stay: Surgical Supplies, Equipment, etc.. *** *** *** SUPPLIES, DIABETIC *** *** *** Chem. Strips, Lancet, Needles, Syringes Glucometer *** *** *** SURGERY - Inpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** SURGERY- Office *** *** *** SURGERY - Outpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** THERAPEUTIC INJECTIONS *** *** *** THERAPY: Physical, Occupational, Speech *** *** *** • Inpatient *** *** *** • Outpatient/Office *** *** *** TRANSPLANTS (Non-experimental) *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** • Organ Procurement *** *** *** • Covered Immunosupressives *** *** *** TRANSPLANT EVALUATIONS *** *** *** • Professional *** *** *** • Facility *** *** *** URGENT CARE VISITS – In-Area *** *** *** URGENT CARE VISITS – Out-of-Area *** *** *** VISION CARE *** *** *** • Exams and Medically Necessary Care *** *** *** • Implanted Lenses (Cataract Surgery) *** *** *** • Lenses and Frames (Non-Cataract) *** *** *** *** All references to the division of financial responsibility have been deleted. ADDENDUM D PREFERRED PROVIDER ORGANIZATION (PPO) EXCLUSIVE PROVIDER ORGANIZATION (EPO) POINT OF SERVICE (POS) BENEFIT PROGRAMS PPG understands that Affiliates or Payors contracted with FHS who are qualified may provide PPO, EPO and POS Benefit Programs. FHS shall provide PPG with a listing of all such Payors, as updated from time to time by FHS. Notwithstanding any provision in this Agreement, PPG and Member Physicians understand and agree that each Payor is solely responsible for paying PPG and/or Member Physicians for those individuals to whom Payor provides health care coverage. In no event shall FHS or any FHS Affiliate be responsible for any payment which is the financial responsibility of a Payor and PPG shall seek compensation for such services only from Pursuant to Section 8.18, Entire Agreement, PPG understands and agrees that the compensation and provisions under the agreement between PPG and the entity formerly known as Foundation Health, a California Health Plan, is applicable to those PPO, EPO and POS Members with Foundation Health Identification Cards and such agreement shall remain in full force and effect for those PPO, EPO and POS Members. PPG shall be compensated according to this Addendum D and this Addendum shall be applicable to those PPO, EPO and POS Members with Health Net or other FHS Affiliate Identification Cards.

SUPPLEMENTAL BENEFITS COSTS. For purposes of calculating PPG’s Capitation, the specific amounts set forth below as a percent of the applicable HCFA payment and the county premium, if any, shall be withheld to cover the actual cost of supplemental benefits that are not PPG Capitated Services, and commissions and taxes, if any. Such supplemental benefits may include, but are not limited to, pharmacy, vision, and dental benefits. On an annual basis, these withheld amounts shall be revised, forwarded to PPG, and incorporated into this Agreement by reference. County Percent Alameda 5.71 % Butte 0.55 % Colusa 0.52 % Contra Costa 5.68 % El Dorado 5.22 % Fresno 5.11 % Xxxxx 0.57 % Xxxx 11.80 % Los Angeles 9.27 % Madera 4.90 % Marin 4.09 % Mariposa 5.42 % Napa 0.48 % Orange 10.03 % Placer 6.71 % Plumas 0.55 % Riverside 12.08 % Sacramento 6.01 % San Bernadino 11.57 % San Diego 11.27 % San Francisco 5.90 % San Xxxxxxx 7.03 % San Xxxx Obispo 11.37 % San Matco 7.16 % Santa Xxxxxxx 11.28 % Santa Xxxxx 6.68 % Sierra 0.58 % Xxxxxx 0.59 % Sonoma 5.28 % Stanislaus 7.09 % Sutter 0.57 % Tulare 4.91 % Ventura 11.81 % Yolo 5.35 % Yuba 0.55 % 72 ADDENDUM C.2 PHARMACY SHARED RISK BUDGETS For purposes of calculating PPG’s Pharmacy Budget, the specific amounts set forth below as a percent of the applicable HCFA payment and the county premium, if any, are applicable. On an annual basis, these amounts shall be revised, forwarded to PPG, and incorporated into this Agreement by reference. County Percent Alameda 4.48 % Butte 0.00 % Colusa 0.00 % Contra Costa 4.45 % El Dorado 4.60 % Fresno 4.42 % Xxxxx 0.00 % Xxxx 10.35 % Los Angeles 8.14 % Madera 4.25 % Marin 3.58 % Mariposa 4.69 % Napa 0.00 % Orange 8.80 % Placer 5.26 % Plumas 0.00 % Riverside 11.51 % Sacramento 4.67 % San Bernadino 11.02 % San Diego 9.89 % San Francisco 4.62 % San Xxxxxxx Josquin 5.51 % San Xxxx Obispo 10.66 % San Mateo 5.61 % Santa Xxxxxxx 10.58 % Santa Xxxxx 5.24 % Sierra 0.00 % Xxxxxx 0.00 % Sonoma 4.70 % Stanislaus 5.55 % Sutter 0.00 % Tulare Talare 4.25 % Ventura 11.25 % Yolo 4.71 % Yuba 0.00 % ADDENDUM C.3 DIVISION OF FINANCIAL RESPONSIBILITY MATRIX OF HMO AND PPG CAPITATED SERVICES MEDICARE BENEFIT PROGRAM The following matrix outlines the division of financial responsibility between FHS, PPG and Hospital. The matrix is intended only as a summary guide. The applicable Subscriber’s Certificate should be consulted for an accurate and complete description of Covered Services and the Provider Operations Manual for clarification. MATRIX EFFECTIVE 1/1/98 6/1/98 PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES AIDS - Facility Component *** *** *** AIDS - Professional Component *** *** *** AIDS - Drugs *** *** *** ALLERGY IMMUNOTHERAPY *** *** *** ALLERGY TESTING *** *** *** ALPHA-FETOPROTEIN *** *** *** AMBULANCE *** *** *** In Area (30 Mile Radius) *** *** *** Out-of-Area *** *** *** ANESTHESIOLOGY *** *** *** BIOFEEDBACK *** *** *** BLOOD/BLOOD PRODUCTS *** *** *** Blood Bank *** *** *** Autologous/Homologous *** *** *** Storage and Collection of Blood *** *** *** CHEMICAL DEPENDENCY *** *** *** • Inpatient Facility Component *** *** *** • Inpatient Professional Component *** *** *** • Outpatient Facility Component *** *** *** • Outpatient Professional Component *** *** *** CHEMOTHERAPY *** *** *** • Drugs, including Epogen, Napugen Nupogen and adjunctive therapies *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** CHIROPRACTIC (Medicare Approved) *** *** *** COLOSTOMY SUPPLIES *** *** *** CONSULTATIONS *** *** *** COSMETIC SURGERY *** *** *** (Medically Necessary) *** *** *** Professional Component *** *** *** Facility Component *** *** *** CRITICAL CARE VISITS *** *** *** DENTAL SERVICES *** *** *** (When a covered benefit) *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** *** All references to the division of financial responsibility have been deleted. 77 PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES DIAGNOSTIC TESTING - Outpatient Facility & Professional *** *** *** DURABLE MEDICAL EQUIPMENT *** *** *** • Outpatient *** *** *** • Surgically Implanted *** *** *** EMERGENCY ADMISSIONS – In-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EMERGENCY ADMISSIONS - Out-of-Area *** *** *** of -Area • Facility Component *** *** *** • Professional Component *** *** *** EMERGENCY ROOM VISITS - In-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EMERGENCY ROOM VISITS – Out-of-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EXTENDED CARE/SKILLED NURSING FACILITY *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** GROWTH HORMONES *** *** *** HEARING AIDS *** *** *** HEMODIALYSIS *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** • Epogen, Nupogen *** *** *** HEPATITIS-B *** *** *** HOME HEALTH *** *** *** HOME VISITS *** *** *** HOSPICE *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** HOSPITAL BASED PHYSICIANS – Inpatient, Ambulatory Surgery or Emergency Room *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** IMMUNIZATIONS *** *** *** *** *** *** INFANT APNEA MONITOR *** *** *** INJECTIBLES, SELF ADMINISTERED *** *** *** INPATIENT VISITS *** *** *** *** All references to the division of financial responsibility have been deleted. PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES INPATIENT VISITS *** *** *** IVF & GIFT *** *** *** Professional Component *** *** *** Facility Component *** *** *** LITHOTRIPSY *** *** *** Professional Component *** *** *** Facility Component *** *** *** MATERNITY - Deliveries and Non-Deliveries *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** MEDICAL ADMISSIONS *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** MENTAL HEALTH - Inpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** MENTAL HEALTH - Outpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** OFFICE VISITS *** *** *** PATIENT EDUCATION *** *** *** PATHOLOGY - Inpatient, Ambulatory Surgery or Emergency Room *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** PATHOLOGY - Office *** *** *** PATHOLOGY - Outpatient *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** PERIODIC EXAMS *** *** *** PRE ADMISSION - Outpatient *** *** *** Laboratory, X-ray *** *** *** (within 72 hrs. or related admission) *** *** *** PROSTHETIC/ORTHOTIC DEVICES *** *** *** • Outpatient *** *** *** • Surgically Implanted *** *** *** RADIOLOGY - Inpatient, Ambulatory Surgery or Emergency Room *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** RADIOLOGY - Office *** *** *** RADIOLOGY - Outpatient *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** SPEECH AND HEARING EXAMS *** *** *** *** All references to the division of financial responsibility have been deleted. PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES SUPPLIES- Medical, Surgical, Office *** *** *** • Related to an Outpatient Office Visit: Splints, Casts, Bandages, etc... *** *** *** • Related to a Hospital Stay: Surgical Supplies, Equipment, etc.. ... *** *** *** SUPPLIES, DIABETIC *** *** *** Chem. Strips, Lancet, Needles, Syringes Glucometer *** *** *** SURGERY - Inpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** SURGERY- SURGERY - Office *** *** *** SURGERY - Outpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** THERAPEUTIC INJECTIONS *** *** *** THERAPY: Physical, Occupational, Speech *** *** *** • Inpatient *** *** *** • Outpatient/Office *** *** *** TRANSPLANTS (Non-experimental) *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** • Organ Procurement *** *** *** • Covered Immunosupressives *** *** *** TRANSPLANT EVALUATIONS *** *** *** • Professional *** *** *** • Facility *** *** *** URGENT CARE VISITS – - In-Area *** *** *** URGENT CARE VISITS – Out-Out-of-Area *** *** *** VISION CARE *** *** *** • Exams and Medically Necessary Care *** *** *** • Implanted Lenses (Cataract Surgery) *** *** *** • Lenses and Frames (Non-Cataract) *** *** *** *** All references to the division of financial responsibility have been deleted. ADDENDUM D PREFERRED PROVIDER ORGANIZATION (PPO) EXCLUSIVE PROVIDER ORGANIZATION (EPO) POINT OF SERVICE (POS) BENEFIT PROGRAMS PPG understands that Affiliates or Payors contracted with FHS who are qualified may provide PPO, EPO and POS Benefit Programs. FHS shall provide PPG with a listing of all such Payors, as updated from time to time by FHS. Notwithstanding any provision in this Agreement, . PPG and Member Physicians understand and agree that each Payor is solely responsible for paying PPG and/or Member Physicians for those individuals to whom Payor provides health care coverage. In no event shall FHS or any FHS Affiliate be responsible for any payment which is the financial responsibility of a Payor and PPG shall seek compensation for such services only from Pursuant to Section 8.18, Entire Agreement, PPG understands and agrees that the compensation and provisions under the agreement between PPG and the entity formerly known as Foundation Health, a California Health Plan, is applicable to those PPO, EPO and POS Members with Foundation Health Identification Cards and such agreement shall remain in full force and effect for those PPO, EPO and POS Members. PPG shall be compensated according to this Addendum D and this Addendum shall be applicable to those PPO, EPO and POS Members with Health Net or other FHS Affiliate Identification Cards.

SUPPLEMENTAL BENEFITS COSTS. For purposes of calculating PPG’s Capitation, the specific amounts set forth below as a percent of the applicable HCFA payment and the county premium, if any, shall be withheld to cover the actual cost of supplemental benefits that are not PPG Capitated Services, and commissions and taxes, if any. Such supplemental benefits may include, but are not limited to, pharmacy, vision, and dental benefits. On an annual basis, these withheld amounts shall be revised, forwarded to PPG, and incorporated into this Agreement by reference. County Percent Alameda 5.71 % Butte 0.55 % Colusa 0.52 % Contra Costa 5.68 % El Dorado 5.22 % Fresno 5.11 % Xxxxx 0.57 % Xxxx 11.80 % Los Angeles 9.27 % Madera 4.90 % Marin 4.09 % Mariposa 5.42 % Napa 0.48 % Orange 10.03 % Placer 6.71 % Plumas 0.55 % Riverside 12.08 % Sacramento 6.01 % San Bernadino 11.57 % San Diego 11.27 % San Francisco 5.90 % San Xxxxxxx 7.03 % San Xxxx Obispo 11.37 % San Matco Mateo 7.16 % Santa Xxxxxxx 11.28 % Santa Xxxxx 6.68 % Sierra 0.58 % Xxxxxx 0.59 % Sonoma 5.28 % Stanislaus 7.09 7.0? % Sutter 0.57 % Tulare 4.91 % Ventura 11.81 % Yolo 5.35 % Yuba 0.55 % 76 ADDENDUM C.2 PHARMACY SHARED RISK BUDGETS For purposes of calculating PPG’s Pharmacy Budget, the specific amounts set forth below as a percent of the applicable HCFA payment and the county premium, if any, are applicable. On an annual basis, these amounts shall be revised, forwarded to PPG, and incorporated into this Agreement by reference. County Percent Alameda 4.48 % Butte 0.00 % Colusa 0.00 % Contra Costa 4.45 % El Dorado 4.60 % Fresno 4.42 % Xxxxx 0.00 % Xxxx 10.35 % Los Angeles 8.14 % Madera 4.25 % Marin 3.58 % Mariposa 4.69 % Napa 0.00 % Orange 8.80 % Placer 5.26 % Plumas 0.00 % Riverside 11.51 % Sacramento 4.67 % San Bernadino 11.02 % San Diego 9.89 % San Francisco 4.62 % San Xxxxxxx 5.51 % San Xxxx Obispo 10.66 % San Mateo 5.61 % Santa Xxxxxxx 10.58 % Santa Xxxxx 5.24 % Sierra 0.00 % Xxxxxx 0.00 % Sonoma 4.70 % Stanislaus 5.55 % Sutter 0.00 % Tulare 4.25 % Ventura 11.25 % Yolo 4.71 % Yuba 0.00 % 77 ADDENDUM C.3 DIVISION OF FINANCIAL RESPONSIBILITY MATRIX OF HMO AND PPG CAPITATED SERVICES MEDICARE BENEFIT PROGRAM The following matrix outlines the division of financial responsibility between FHS, PPG and Hospital. The matrix is intended only as a summary guide. The applicable Subscriber’s Certificate should be consulted for an accurate and complete description of Covered Services and the Provider Operations Manual for clarification. MATRIX EFFECTIVE 1/1/98 PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES AIDS - Facility Component *** *** *** AIDS - Professional Component *** *** *** AIDS - Drugs *** *** *** ALLERGY IMMUNOTHERAPY *** *** *** ALLERGY TESTING *** *** *** ALPHA-FETOPROTEIN *** *** *** AMBULANCE *** *** *** In Area (30 Mile Radius) *** *** *** Out-of-Area *** *** *** ANESTHESIOLOGY *** *** *** BIOFEEDBACK *** *** *** BLOOD/BLOOD PRODUCTS *** *** *** Blood Bank *** *** *** Autologous/Homologous *** *** *** Storage and Collection of Blood *** *** *** CHEMICAL DEPENDENCY *** *** *** • Inpatient Facility Component *** *** *** • Inpatient Professional Component *** *** *** • Outpatient Facility Component *** *** *** • Outpatient Professional Component *** *** *** CHEMOTHERAPY *** *** *** • Drugs, including Epogen, Napugen Nupogen and adjunctive therapies *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** CHIROPRACTIC (Medicare Approved) *** *** *** COLOSTOMY SUPPLIES *** *** *** CONSULTATIONS *** *** *** COSMETIC SURGERY *** *** *** (Medically Necessary) *** *** *** Professional Component *** *** *** Facility Component *** *** *** CRITICAL CARE VISITS *** *** *** DENTAL SERVICES *** *** *** (When a covered benefit) *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** *** All references to the division of financial responsibility have been deleted. 77 PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES DIAGNOSTIC TESTING - Outpatient Facility & Professional *** *** *** DURABLE MEDICAL EQUIPMENT *** *** *** • Outpatient *** *** *** • Surgically Implanted *** *** *** EMERGENCY ADMISSIONS – In-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EMERGENCY ADMISSIONS - Out-of-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EMERGENCY ROOM VISITS - In-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EMERGENCY ROOM VISITS – Out-of-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EXTENDED CARE/SKILLED NURSING FACILITY *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** GROWTH HORMONES *** *** *** HEARING AIDS *** *** *** HEMODIALYSIS *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** • Epogen, Nupogen *** *** *** HEPATITIS-B *** *** *** HOME HEALTH *** *** *** HOME VISITS *** *** *** HOSPICE *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** HOSPITAL BASED PHYSICIANS – - Inpatient, Ambulatory Surgery or Emergency Room *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** IMMUNIZATIONS *** *** *** *** *** *** INFANT APNEA MONITOR *** *** *** INJECTIBLES, SELF ADMINISTERED *** *** *** *** All references reference to the division of financial responsibility have been deleted. MATRIX EFFECTIVE 1/1/98 PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES INPATIENT VISITS *** *** *** IVF & GIFT *** *** *** Professional Component *** *** *** Facility Component *** *** *** LITHOTRIPSY *** *** *** Professional Component *** *** *** Facility Component *** *** *** MATERNITY - Deliveries and Non-Deliveries *** *** *** • Facility Facilily Component *** *** *** • Professional Component *** *** *** MEDICAL ADMISSIONS *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** MENTAL HEALTH - Inpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** MENTAL HEALTH - Outpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** OFFICE VISITS *** *** *** PATIENT EDUCATION *** *** *** PATHOLOGY - Inpatient, Ambulatory Surgery or Emergency Room *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** PATHOLOGY - Office *** *** *** PATHOLOGY - Outpatient *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** PERIODIC EXAMS *** *** *** PRE ADMISSION - Outpatient *** *** *** LaboratoryLaboratorty, X-ray *** *** *** (within 72 hrs. or related admission) *** *** *** PROSTHETIC/ORTHOTIC DEVICES *** *** *** • Outpatient *** *** *** • Surgically Implanted *** *** *** RADIOLOGY - Inpatient, Ambulatory Surgery or Emergency Room *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** RADIOLOGY - Office *** *** *** RADIOLOGY - Outpatient *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** SPEECH AND HEARING EXAMS *** *** *** *** All references reference to the division of financial responsibility have been deleted. PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES SUPPLIES- Medical, Surgical, Office *** *** *** • Related to an Outpatient Office Visit: *** *** *** Splints, Casts, Bandages, etc... ., *** *** *** • Related to a Hospital Stay: *** *** *** Surgical Supplies, Equipment, etc.. ., *** *** *** SUPPLIES, DIABETIC *** *** *** Chem. Strips, Lancet, Needles, Syringes Glucometer Glueometer *** *** *** SURGERY - Inpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** SURGERY- SURGERY - Office *** *** *** SURGERY - Outpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** THERAPEUTIC INJECTIONS *** *** *** THERAPY: Physical, Occupational, Speech *** *** *** • Inpatient *** *** *** • Outpatient/Office *** *** *** TRANSPLANTS (Non-experimental) *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** • Organ Procurement *** *** *** • Covered Immunosupressives *** *** *** TRANSPLANT EVALUATIONS *** *** *** • Professional *** *** *** • Facility *** *** *** URGENT CARE VISITS – In-Area *** *** *** URGENT CARE VISITS – Out-of-Area *** *** *** VISION CARE *** *** *** • Exams and Medically Necessary Care *** *** *** • Implanted Lenses (Cataract Surgery) *** *** *** • Lenses and Frames (Non-Cataract) *** *** *** *** All references reference to the division of financial responsibility have been deleted. ADDENDUM D PREFERRED PROVIDER ORGANIZATION (PPO) EXCLUSIVE PROVIDER ORGANIZATION (EPO) POINT OF SERVICE (POS) BENEFIT PROGRAMS PPG understands that Affiliates or Payors contracted with FHS who are qualified may provide PPO, EPO and POS Benefit Programs. FHS shall provide PPG with a listing of all such Payors, as updated from time to time by FHS. Notwithstanding any provision in this Agreement, PPG and Member Physicians understand and agree that each Payor is solely responsible for paying PPG and/or Member Physicians for those individuals to whom Payor provides health care coverage. In no event shall FHS or any FHS Affiliate be responsible for any payment which is the financial responsibility of a Payor and PPG shall seek compensation for such services only from Pursuant to Section 8.18, Entire Agreement, PPG understands and agrees that the compensation and provisions under the agreement between PPG and the entity formerly known as Foundation Health, a California Health Plan, is applicable to those PPO, EPO and POS Members with Foundation Health Identification Cards and such agreement shall remain in full force and effect for those PPO, EPO and POS Members. PPG shall be compensated according to this Addendum D and this Addendum shall be applicable to those PPO, EPO and POS Members with Health Net or other FHS Affiliate Identification Cards.PROGRAMS

SUPPLEMENTAL BENEFITS COSTS. For purposes of calculating PPG’s Capitation, the specific amounts set forth below as a percent of the applicable HCFA payment and the county premium, if any, any shall be withheld to cover the actual cost of supplemental benefits that are not PPG Capitated Services, and commissions and taxes, if any. Such supplemental benefits may include, but are not limited to, pharmacy, vision, and dental benefits. On an .an annual basis, these withheld amounts shall be revised, forwarded to PPG, and incorporated into this Agreement by reference. County Percent Alameda 5.71 6.58 % Butte 0.55 Buite 0.00 % Colusa 0.52 0,00 % Contra Costa 5.68 7.58 % El Dorado 5.22 5.66 % Fresno 5.11 6.17 % Xxxxx 0.57 Gxxxx 0.00 % Xxxx 11.80 Kxxx 12.26 % Los Angeles 9.27 7.42 % Madera 4.90 5.93 % Marin 4.09 4.66 % Mariposa 5.42 6.23 % Napa 0.48 0.00 % Orange 10.03 8.80 % Placer 6.71 7.48 % Plumas 0.55 0.00 % Riverside 12.08 6.13 % Sacramento 6.01 9.06 % San Bernadino 11.57 Bernardino 6.17 % San Diego 11.27 9.70 % San Francisco 5.90 6.09 % San Xxxxxxx 7.03 Jxxxxxx 8.56 % San Xxxx Lxxx Obispo 11.37 0.00 % San Matco 7.16 Mateo 7.82 % Sxxxx Xxxxxxx 8.58 % Santa Xxxxxxx 11.28 % Santa Xxxxx 6.68 Cxxxx 8.11 % Sierra 0.58 0.00 % Xxxxxx 0.59 Sxxxxx 0.00 % Sonoma 5.28 4.83 % Stanislaus 7.09 Slanislaus 7.26 % Sutter 0.57 0.00 % Tulare 4.91 0.00 % Ventura 11.81 6.24 % Yolo 5.35 7.12 % Yuba 0.55 Yuha 0.00 % ADDENDUM C.2 PHARMACY SHARED RISK BUDGETS For purposes of calculating PPG’s Pharmacy Budget, the specific amounts set forth below as a percent of the applicable HCFA payment and the county premium, if any, are applicable. On an annual basis, these amounts shall be revised, forwarded to PPG, and incorporated into this Agreement by reference. County Percent Alameda 4.48 5.40 % Butte Buite 0.00 % Colusa 0.00 % Contra Costa 4.45 6.40 % El Dorado 4.60 5.05 % Fresno 4.42 5.56 % Xxxxx Gxxxx 0.00 % Xxxx 10.35 Kxxx 10.86 % Los Angeles 8.14 6.32 % Madera 4.25 5.32 % Marin 3.58 4.17 % Mariposa 4.69 5.60 % Napa 0.00 % Orange 8.80 7.61 % Placer 5.26 6.16 % Plumas 0.00 % Riverside 11.51 5.61 % Sacramento 4.67 7.84 % San Bernadino 11.02 5.67 % San Diego 9.89 8.36 % San Francisco 4.62 4.88 % San Xxxxxxx 5.51 Jxxxxxx 7.19 % San Xxxx Lxxx Obispo 10.66 0.00 % San Mateo 5.61 6.35 % Santa Xxxxxxx 10.58 Bxxxxxx 7.97 % Santa Xxxxx 5.24 Cxxxx 6.71 % Sierra 0.00 % Xxxxxx Sxxxxx 0.00 % Sonoma 4.70 4.30 % Stanislaus 5.55 5.84 % Sutter 0.00 % Tulare 4.25 0.00 % Ventura 11.25 5.73 % Yolo 4.71 6.50 % Yuba 0.00 % ADDENDUM C.3 DIVISION OF FINANCIAL RESPONSIBILITY MATRIX OF HMO AND PPG CAPITATED SERVICES MEDICARE BENEFIT PROGRAM The following matrix outlines the division of financial responsibility between FHSHMO, PPG and Hospital. The matrix is intended only as a summary guide. The applicable Subscriber’s Certificate should be consulted for an accurate and complete description of Covered Services and the Provider Operations Manual for clarification. MATRIX EFFECTIVE 1/1/98 1/1/99 PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES AIDS - Facility Component *** *** *** AIDS - Professional Component *** *** *** AIDS - Drugs *** *** *** ALLERGY IMMUNOTHERAPY *** *** *** ALLERGY TESTING *** *** *** ALPHA-FETOPROTEIN *** *** *** AMBULANCE *** *** *** In Area (30 Mile Radius) *** *** *** Out-of-Area *** *** *** ANESTHESIOLOGY *** *** *** BIOFEEDBACK *** *** *** BLOOD/BLOOD PRODUCTS *** *** *** Blood Bank *** *** *** Autologous/Homologous *** *** *** Storage and Collection of Blood *** *** *** CHEMICAL DEPENDENCY *** *** *** • Inpatient Facility Component *** *** *** • Inpatient Professional Component *** *** *** • Outpatient Facility Component *** *** *** • Outpatient Professional Component *** *** *** CHEMOTHERAPY *** *** *** • Drugs, including Epogen, Napugen Neupogen and adjunctive therapies *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** CHIROPRACTIC (Medicare Approved) *** *** *** COLOSTOMY SUPPLIES *** *** *** CONSULTATIONS *** *** *** COSMETIC SURGERY *** *** *** (Medically Necessary) *** *** *** Professional Component *** *** *** Facility Component *** *** *** CRITICAL CARE VISITS *** *** *** DENTAL SERVICES *** *** *** (When a covered benefit) *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** *** All references to the division of financial responsibility have been deleted. 77 PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES DIAGNOSTIC TESTING - Outpatient Facility & Professional *** *** *** DURABLE MEDICAL EQUIPMENT *** *** *** • Outpatient *** *** *** • Surgically Implanted *** *** *** EMERGENCY ADMISSIONS – In-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EMERGENCY ADMISSIONS - Out-of-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EMERGENCY ROOM VISITS - In-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EMERGENCY ROOM VISITS – Out-of-Area *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** EXTENDED CARE/SKILLED NURSING FACILITY *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** GROWTH HORMONES *** *** *** HEARING AIDS *** *** *** HEMODIALYSIS *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** • Epogen, Nupogen *** *** *** HEPATITIS-B *** *** *** HOME HEALTH *** *** *** HOME VISITS *** *** *** HOSPICE *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** HOSPITAL BASED PHYSICIANS – Inpatient, Ambulatory Surgery or Emergency Room *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** IMMUNIZATIONS *** *** *** *** *** *** INFANT APNEA MONITOR *** *** *** INJECTIBLES, SELF ADMINISTERED *** *** *** *** All references to the division of financial responsibility have been deleted. PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES INPATIENT VISITS *** *** *** IVF & GIFT *** *** *** Professional Component *** *** *** Facility Component *** *** *** LITHOTRIPSY *** *** *** Professional Component *** *** *** Facility Component *** *** *** MATERNITY - Deliveries and Non-Deliveries *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** MEDICAL ADMISSIONS *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** MENTAL HEALTH - Inpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** MENTAL HEALTH - Outpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** OFFICE VISITS *** *** *** PATIENT EDUCATION *** *** *** PATHOLOGY - Inpatient, Ambulatory Surgery or Emergency Room *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** PATHOLOGY - Office *** *** *** PATHOLOGY - Outpatient *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** PERIODIC EXAMS *** *** *** PRE ADMISSION - Outpatient *** *** *** Laboratory, X-ray *** *** *** (within 72 hrs. or related admission) *** *** *** PROSTHETIC/ORTHOTIC DEVICES *** *** *** • Outpatient *** *** *** • Surgically Implanted *** *** *** RADIOLOGY - Inpatient, Ambulatory Surgery or Emergency Room *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** RADIOLOGY - Office *** *** *** RADIOLOGY - Outpatient *** *** *** • Professional Component *** *** *** • Technical Component *** *** *** SPEECH AND HEARING EXAMS *** *** *** *** All references to the division of financial responsibility have been deleted. PPG CAPITATED SERVICES HMO RISK SERVICES SHARED RISK/HOSPITAL CAPITATED SERVICES SUPPLIES- Medical, Surgical, Office *** *** *** • Related to an Outpatient Office Visit: Splints, Casts, Bandages, etc... *** *** *** • Related to a Hospital Stay: Surgical Supplies, Equipment, etc.. *** *** *** SUPPLIES, DIABETIC *** *** *** Chem. Strips, Lancet, Needles, Syringes Glucometer *** *** *** SURGERY - Inpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** SURGERY- Office *** *** *** SURGERY - Outpatient *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** THERAPEUTIC INJECTIONS *** *** *** THERAPY: Physical, Occupational, Speech *** *** *** • Inpatient *** *** *** • Outpatient/Office *** *** *** TRANSPLANTS (Non-experimental) *** *** *** • Facility Component *** *** *** • Professional Component *** *** *** • Organ Procurement *** *** *** • Covered Immunosupressives *** *** *** TRANSPLANT EVALUATIONS *** *** *** • Professional *** *** *** • Facility *** *** *** URGENT CARE VISITS – In-Area *** *** *** URGENT CARE VISITS – Out-of-Area *** *** *** VISION CARE *** *** *** • Exams and Medically Necessary Care *** *** *** • Implanted Lenses (Cataract Surgery) *** *** *** • Lenses and Frames (Non-Cataract) *** *** *** *** All references to the division of financial responsibility have been deleted. ADDENDUM D PREFERRED PROVIDER ORGANIZATION (PPO) EXCLUSIVE PROVIDER ORGANIZATION (EPO) POINT OF SERVICE (POS) BENEFIT PROGRAMS PPG understands that Affiliates or Payors contracted with FHS who are qualified may provide PPO, EPO and POS Benefit Programs. FHS shall provide PPG with a listing of all such Payors, as updated from time to time by FHS. Notwithstanding any provision in this Agreement, PPG and Member Physicians understand and agree that each Payor is solely responsible for paying PPG and/or Member Physicians for those individuals to whom Payor provides health care coverage. In no event shall FHS or any FHS Affiliate be responsible for any payment which is the financial responsibility of a Payor and PPG shall seek compensation for such services only from Pursuant to Section 8.18, Entire Agreement, PPG understands and agrees that the compensation and provisions under the agreement between PPG and the entity formerly known as Foundation Health, a California Health Plan, is applicable to those PPO, EPO and POS Members with Foundation Health Identification Cards and such agreement shall remain in full force and effect for those PPO, EPO and POS Members. PPG shall be compensated according to this Addendum D and this Addendum shall be applicable to those PPO, EPO and POS Members with Health Net or other FHS Affiliate Identification Cards.