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EXHIBIT 10.2
*CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND
FILED SEPARATELY WITH THE COMMISSION.
FIRST AMENDMENT
OF
RISK SHARING AGREEMENT
BY AND BETWEEN
ALLEGHENY HEALTH, EDUCATION & RESEARCH FOUNDATION
AND
COVENTRY CORPORATION
ON BEHALF OF MEMBER COMPANIES
THIS AMENDMENT of Risk Sharing Agreement ("Agreement") by and between Allegheny
Health, Education & Research Foundation ("AHERF") and Coventry Corporation
("Coventry"), on behalf of its Member Companies, is entered into this 11th day
of June, 1997.
The parties agree that Section 4.2.1.6, Delegated Functions, shall be amended
to include the following:
4.2.1.5.6 Specific Delegation. The parties hereby agree that effective
June 1, 1997, the following functions are hereby delegated to
AHERF or its designee to perform on behalf of Coventry and its
Member Companies: utilization review/management,
authorizations/referrals, credentialing, monitoring of quality
of care, monitoring of quality of service, and disease
management.
For the period June 1, 1997 through December 31, 1997, Coventry
will pay AHERF [___]*.
From January 1, 1998, through the end of the contract term,
Coventry will pay AHERF for the performance of the
aforementioned delegated functions a percentage of premiums as
determined by the specific number of Covered Individuals
associated with each respective threshold set forth below.
Example: [___]*
Commercial Medicare
--------------------------- ------------------------------------
Covered
Individuals 200,000 3000,000 400,000 0 50,000 100,000 200,000
--------------------------- ------------------------------------
Percentage of
Premium for
Delegated
Functions [___]* [___]* [___]* [___]* [___]* [___]* [___]*
-------------------------- ------------------------------------
For purposes of this Amendment only, Covered Individual shall also include any
individual associated with self-insured health care benefit plans administered
by HealthAmerica or other Member Company. The rate for said self-insured
Covered Individuals shall be mutually agreed upon by the parties.
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The parties agree that Section 4.2.1.4., Standard of Performance, shall be
incorporated herein by references, and further the parties agree to negotiate
in good faith to develop formal performance standards, upon mutually acceptable
terms, which standards shall be memorialized in a subsequent amendment.
IN WITNESS WHEREOF, the parties have executed this Amendment as of the date
first above written.
Allegheny Health, Education HealthAmerica Pennsylvania, Inc.
& Research Foundation
/s/ Xxxxx X. XxXxxxxxx /s/ Xxxxxx X. Xxxxx
---------------------------- -------------------------------------
Executive Vice President and Xxxxxx X. Xxxxx
Chief Financial Officer President and Chief Executive Officer
Coventry Corporation
/s/ Xxxxxx X. Xxxxx
-------------------------------------
Xxxxxx X. Xxxxx
Senior Vice President
