LETTER OF AGREEMENT SERVING AS ADDENDUM TO THE MEDICAL SERVICES AGREEMENT BETWEEN BLUE CROSS OF CALIFORNIA AND PROSPECT HEALTH SOURCE MEDICAL GROUP
Exhibit 10.166
Letter of Agreement Serving as Addendum to the January 1, 2001 California Care Medical Services Agreement between Blue Cross of California and Prospect Health Source Medical Group, effective January 1, 2001
*** Confidential Treatment requested
LETTER OF
AGREEMENT
SERVING AS ADDENDUM TO THE MEDICAL SERVICES AGREEMENT
BETWEEN BLUE CROSS OF CALIFORNIA AND
PROSPECT HEALTH SOURCE MEDICAL GROUP
This will serve as a confirmation letter in which Blue Cross of California (“BLUE CROSS”) has agreed to the following terms of the CaliforniaCare Medical Services Agreement between BLUE CROSS and Prospect Health Source Medical Group (“PARTICIPATING MEDICAL GROUP”) effective January 1, 2001.
Article VIII, Enrollment Protection, is hereby deleted in its entirety and is replaced by the following:
A. BLUE CROSS and PARTICIPATING MEDICAL GROUP agree that PARTICIPATING MEDICAL GROUP shall assume full financial responsibility and liability for all Capitation Services. BLUE CROSS agrees to compensate PARTICIPATING MEDICAL GROUP *** per Member per month in addition to the Capitation due pursuant to the Capitation rates contained in this Agreement.
B. Prior to execution of this Agreement, PARTICIPATING MEDICAL GROUP shall provide to BLUE CROSS the following: (i) PARTICIPATING MEDICAL GROUP’s financial statement for its immediately preceding two (2) fiscal years; (ii) PARTICIPATING MEDICAL GROUP’s cumulative financial statements for the current fiscal year; and (iii) PARTICIPATING MEDICAL GROUP’s federal income tax returns for the immediately preceding two (2) years.
C. PARTICIPATING MEDICAL GROUP shall provide to BLUE CROSS evidence of coverage or reinsurance for professional services stop-loss with a carrier or self-insurance program acceptable to BLUE CROSS, within thirty (30) days of execution of this Agreement.
1
Letter
of Agreement between Blue Cross and
PARTICIPATING MEDICAL GROUP
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Exhibit G. Section II, |
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Item 5 of this section is amended to read: |
Total claims for Out-of-Network Expenses rendered to any single BLUE CROSS PLUS Member during the calendar year shall be limited to 140% of twenty five thousand dollars ($25,000), or thirty five thousand dollars ($35,000).
Upon acceptance of the parties, this letter, as of the effective date, shall become part of the Medical Services Agreement.
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BLUE CROSS OF CALIFORNIA |
PARTICIPATING MEDICAL GROUP |
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Signature: |
/s/ Xxxxx Xxxx |
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Signature: |
/s/ Xxxxx X. Xxxx |
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Name: |
Xxxxx Xxxx |
Name: |
Xxxxx X. Xxxx |
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Title: |
Vice President |
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Title: |
Senior Vice President |
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Network Development & Management |
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Data: |
2-12-01 |
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Data: |
1-25-01 |
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