Adjusted community rate definition

Adjusted community rate means the rating method used to
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Adjusted community rate means the rating method used to establish the premium for health plans adjusted to reflect actuarially demonstrated differences in utilization or cost attributable to geographic region, age, family size, and use of wellness activities.
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Adjusted community rate means a community rate which has been ad- justed for expected use of medical re- sources of the FEHBP group. An ad- justed community rate is a prospective rate and cannot be retroactively re- vised to reflect actual experience, utili- zation, or costs of the FEHBP group, except as described in § 1615.402(c)(4).[55 FR 27414, July 2, 1990, as amended at 62FR 47573, Sept. 10, 1997; 76 FR 38284, June 29,2011] 1602.170–3 Comprehensive medical plan.Comprehensive Medical Plan means a plan as defined under 5 U.S.C. 8903(4).1602.170–4 Contractor.Contractor means carrier.1602.170–5 Cost or pricing data.(a) Experience-rated carriers. Cost or pricing data for experience-rated car- riers includes:
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Examples of Adjusted community rate in a sentence

  • The Owner/Developer further agrees that the City will, if the City and the Owner/Developer mutually deem it appropriate, provide any additional defense to any claim hereunder, the full costs of which shall be borne by the Owner/Developer.

  • Section 1602.170–2(b) is revised to read as follows:§ 1602.170–2 Community rate.* * * * *(b) Adjusted community rate means a community rate which has been adjusted for expected use of medical resources of the FEHBP group.


More Definitions of Adjusted community rate

Adjusted community rate means a community rate which has been adjusted for expected use of medical resources of the FEHBP group. An adjusted community rate is a prospective rate and cannot be retroactively revised to reflect actual experience, utilization, or costs of the FEHBP group, except as described in § 1615.402(c)(4). 1602.170-3 Comprehensive medical plan. Comprehensive Medical Plan means a plan as defined under 5 U.S.C. 8903(4). 1602.170-4 Contractor. Contractor means carrier. 1602.170-5 Cost or pricing data. (a) Experience-rated carriers. Cost or pricing data for experience-rated carriers includes:
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Adjusted community rate means acommunity rate which has been ad- justed for expected use of medical re- sources of the FEHBP group. An ad- justed community rate is a prospective rate and cannot be retroactively re- vised to reflect actual experience, utili- zation, or costs of the FEHBP group.[55 FR 27414, July 2, 1990, as amended at 62FR 47573, Sept. 10, 1997] 1602.170–3 Comprehensive medical plan.Comprehensive Medical Plan means a plan as defined under 5 U.S.C. 8903(4).1602.170–4 Contractor.Contractor means carrier.1602.170–5 Cost or pricing data.(a) Experience rated carriers. Cost or pricing data for experience rated car- riers includes information such as claims data; actual or negotiated bene- fits payments made to providers of medical services for the provision of health care such as capitation not ad- justed for specific groups, per diems, and Diagnostic Related Group (DRG) payments; cost data; utilization data; and administrative expenses and reten- tions.(b) Community rated carriers. Cost orpricing data for community rated car- riers is the specialized rating data used by carriers in computing a rate that is appropriate for the Federal group and the similarly sized subscriber groups (SSSGs). Such data include, but are not limited to, capitation rates; pre- scription drug, hospital, and office visit benefits utilization data; trend data; actuarial data; rating methodologies for other groups; standardized presen- tation of the carrier’s rating method (age, sex, etc.) showing that the factor predicts utilization; tiered rates infor- mation; ‘‘step-up’’ factors information; demographics such as family size; spe- cial benefit loading capitations; and adjustment factors for capitation.[62 FR 47574, Sept. 10, 1997] 1602.170–6 Director.Director means the Director of the Of- fice of Personnel Management.[52 FR 16038, May 1, 1987. Redesignated at 62FR 47574, Sept. 10, 1997] 1602.170–7 Experience rate.Experience rate means a rate for a given group that is the result of that group’s actual paid claims, administra- tive expenses, retentions, and esti- mated claims incurred but not re- ported, adjusted for benefit modifica- tions, utilization trends, and economic trends. Actual paid claims include any actual or negotiated benefits payments made to providers of medical services for the provision of health care such as capitation not adjusted for specific groups, per diems, and Diagnostic Re- lated Group (DRG) payments.[54 FR 27414, July 2, 1990. Redesignated at 62FR 47574, Sept. 10, 19...
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Related to Adjusted community rate

  • Community rate means a rate of payment based on a per member per month capitation rate or its equivalent that applies to a combination of the subscriber groups for a comprehensive medical plan carrier. References in this subchapter to ‘‘a combination of cost and price analysis’’ relating to the ap- plicability of policy and contract clauses refer to comprehensive medical plan carriers using community rates.

  • HICP Daily Inflation Reference Index means (A) in relation to the first calendar day of any given month, the HICP Monthly Reference Index of the third month preceding such month, and (B) in relation to a calendar day (D) (other than the first calendar day) in any given month (M), the linear interpolation of the HICP Monthly Reference Index pertaining respectively to the third month preceding such month (M - 3) and the second month preceding such month (M - 2) calculated in accordance with the following formula:

  • Adjusted CD Rate has the meaning set forth in Section 2.07(b).

  • CPI Daily Inflation Reference Index means (A) in relation to the first day of any given month, the CPI Monthly Reference Index of the third month preceding such month, and (B) in relation to a day (D) (other than the first day) in any given month (M), the linear interpolation of the CPI Monthly Reference Index pertaining respectively to the third month preceding such month (M - 3) and the second month preceding such month (M - 2) calculated in accordance with the following formula:

  • Adjusted Term SOFR Rate for any Interest Period, an interest rate per annum equal to (a) the Term SOFR Rate for such Interest Period, plus (b) 0.10%; provided that if the Adjusted Term SOFR Rate as so determined would be less than the Floor, such rate shall be deemed to be equal to the Floor for the purposes of this Agreement.

  • Federal poverty level means the poverty level as defined by the most recently revised poverty income guidelines published by the United States Department of Health and Human Services in the Federal Register.

  • Adjusted LIBO Rate means, with respect to any Eurodollar Borrowing for any Interest Period, an interest rate per annum (rounded upwards, if necessary, to the next 1/16 of 1%) equal to (a) the LIBO Rate for such Interest Period multiplied by (b) the Statutory Reserve Rate.

  • Adjusted Base Rate means the Base Rate plus the Applicable Percentage.

  • Adjusted Consolidated Net Worth means, at any date, without duplication, the sum of (a) the consolidated shareholders’ equity, determined in accordance with GAAP, of the Guarantor and its Consolidated Subsidiaries, plus (b) the aggregate Hybrid Instrument Amount plus (c) the VA Adjustment Amount; provided that, in determining such Adjusted Consolidated Net Worth, there shall be excluded (i) any “Accumulated Other Comprehensive Income (Loss)” shown on the consolidated balance sheet of the Guarantor and its Consolidated Subsidiaries prepared in accordance with GAAP, (ii) the effect of any election under the fair value option in FASB ASC 825 permitting a Person to measure its financial assets or liabilities at the fair value thereof, and the related tax impact and (iii) all noncontrolling interests (as determined in accordance with Statement of Financial Accounting Standards No. 160, entitled “Noncontrolling Interests in Consolidated Financial Statements”) shown on the consolidated balance sheet of the Guarantor and its Consolidated Subsidiaries.

  • Energy Market Opportunity Cost means the difference between (a) the forecasted cost to operate a specific generating unit when the unit only has a limited number of available run hours due to limitations imposed on the unit by Applicable Laws and Regulations, and (b) the forecasted future Locational Marginal Price at which the generating unit could run while not violating such limitations. Energy Market Opportunity Cost therefore is the value associated with a specific generating unit’s lost opportunity to produce energy during a higher valued period of time occurring within the same compliance period, which compliance period is determined by the applicable regulatory authority and is reflected in the rules set forth in PJM Manual 15. Energy Market Opportunity Costs shall be limited to those resources which are specifically delineated in Operating Agreement, Schedule 2. Energy Resource:

  • Free Margin means the amount of funds available in the Client Account, which may be used to open a position or maintain an Open Position. Free Margin shall be calculated as: Equity less (minus) Necessary Margin [Free margin = Equity- Necessary Margin].

  • NERC Reliability Standards means the most recent version of those reliability standards applicable to the Generating Facility, or to the Generator Owner or the Generator Operator with respect to the Generating Facility, that are adopted by the NERC and approved by the applicable regulatory authorities, which are available at xxxx://xxx.xxxx.xxx/files/Reliability_Standards_Complete_Set.pdf, or any successor thereto.

  • Applicable water quality standards means all water quality standards to which a discharge is subject under the federal Clean Water Act and which has been (a) approved or permitted to remain in effect by the Administrator following submission to the Administrator pursuant to Section 303(a) of the Act, or (b) promulgated by the Director pursuant to Section 303(b) or 303(c) of the Act, and standards promulgated under (APCEC) Regulation No. 2, as amended.

  • Acceptable earned value management system means an earned value management system that generally complies with system criteria in paragraph (b) of this clause.