Plan Name. Mainstream Base Period: CY '93 Plan Number: Rate Period: 6/96 - 9/97 County: Riverside Capitation Payable: End of Month Aid Code: Child
Plan Name. Mainstream Base Period: CY '93 Plan Number: Rate Period: 7/95 - 5/96 County: San Bernardino Capitation Payable: End of Month Aid Code: Disabled Phys Pharm HIP HOP LTC Other Total Units per 1,000 eligibles 7.452 23.494 1.498 4.212 1.440 28.577 Age/sex Adjustment 1.005 .979 .990 1.001 1.011 1.008 Aid Code Adjustment .994 1.003 .983 .993 .999 1.004 Adjusted Units 7.444 23.070 1.458 4.229 1.454 28.921 Average Cost Per Unit 43.31 32.19 511.29 18.05 108.27 10.65 Area Adjustment 1.013 1.000 1.000 1.000 1.000 1.000 Adjusted Cost $ 43.87 $ 32.19 $ 511.29 $ 18.05 $ 108.27 $ 10.65 Interest Adjustment .995 .999 .991 .993 .999 .996 Contract Cost per Eligible $ 324.94 $ 741.88 $ 738.75 $ 75.80 $ 157.27 $ 306.78 $ 2,345.42 Benefit Adjustments FY 94/95 1.003 .852 1.036 1.003 1.042 1.001 FY 95/96 1.000 .724 1.018 1.000 1.020 1.000 Trend Adjustment 7/93 - 1/96 1.115 1.190 .986 1.047 .992 1.233 Annual Cost Per Eligible $ 363.40 $ 544.58 $ 768.21 $ 79.60 $ 165.82 $ 378.64 $ 2,300.25 Mental Health Adjustment 7.8% .0% 11.7% 2.4% 1.3% 1.4% Eyewear Adjustment .9% Cost Excluding Mental Health $ 335.05 $ 544.58 $ 678.33 $ 77.69 $ 163.66 $ 369.98 $ 2,169.29 Preliminary Monthly Rate $ 180.77 Adj. for Fee-for-Service Limitation -2.0% $ -3.62 CHDP .00 Final Rate $ 177.15 Attachment I
Plan Name. Enter the name of the Health Plan.
Examples of Plan Name in a sentence
Here’s a sample UnitedHealthcare member ID card to show you what yours will look like: Your UnitedHealthcare Plan Name (XXX) Sample A.
Individual assigned by Contractor to ensure Contractor's compliance with MFD Subcontractor Performance Plan: Name: Title: Address: City: State: Zip: Phone Number: Fax Number: Email: B.
Other Insurance Company / Dental Benefit Plan Name, Address, City, State, ZIP Code 33.
GENERAL INFORMATION Case Number: (Obtain this information from your Pension Plan Administrator)The Plan Sponsor of (Legal Plan Name as stated on the Program Agreement Face Page)wishes to add the following fund(s) as investment option(s) to the Plan.
Employee Labor CategoryWage per HourName of Health Insurance Provider(s) and Plan Name* (e.g. ABC Insurer, Inc.
More Definitions of Plan Name
Plan Name. Mainstream Base Period: CY '93 Plan Number: Rate Period: 6/96 - 9/97 County: San Bernardino Capitation Payable: End of Month Aid Code: Adult Phys Pharm HIP HOP LTC Other Total Units per 1,000 eligibles 22.752 5.069 3.590 4.465 .000 20.412 Age/sex Adjustment 1.000 1.000 1.000 1.000 1.000 1.000 Aid Code Adjustment 1.000 1.000 1.000 1.000 1.000 1.000 Adjusted Units 22.752 5.069 3.590 4.465 .000 20.412 Average Cost Per Unit 59.80 16.00 960.30 20.51 .00 43.66 Area Adjustment 1.013 1.000 1.000 1.000 1.000 1.000 Adjusted Cost $ 60.58 $ 16.00 $ 960.30 $ 20.51 $ .00 $ 43.66 Interest Adjustment .996 .999 .995 .993 .996 .995 Contract Cost per Eligible $ 1,372.80 $ 81.02 $ 3,430.24 $ 90.94 $ .00 $ 886.73 $ 5,861.73 Benefit Adjustments FY 94/95 1.003 .852 1.035 1.003 1.042 1.013 FY 95/96 1.000 .724 1.018 1.000 1.020 1.000 Trend Adjustment 7/93 - 1/97 1.099 1.023 1.126 1.169 1.000 1.195 Annual Cost Per Eligible $ 1,513.23 $ 51.13 $ 4,069.59 $ 106.63 $ .00 $ 1,073.42 $ 6,814.00 Mental Health Adjustment .1% 2.2% .3% 1.1% .0% .1% Eyewear Adjustment .4% Cost Excluding Mental Health $ 1,511.72 $ 50.01 $ 4,057.38 $ 105.46 $ .00 $ 1,068.06 $ 6,792.63 Preliminary Monthly Rate $ 566.05 Adj. for Fee-for-Service Limitation -2.0% $ -11.32 CHDP .00 Final Rate $ 554.73 Attachment I
Plan Name shall be HAMPSHIRE GROUP, LIMITED AND SUBSIDIARIES 401(k) RETIREMENT SAVINGS PLAN.
Plan Name. Smoker Code: Rider Name: Smoker Code: Life Rates: Reserve Basis:
Plan Name. Peet's Coffee & Tea, Inc. Savings & Retirement Plan. _______________________________________________________ Implementation Date: 04/01/1999 Number of Eligible Employees: 331 --- Number of Participants: __________ Select One: [_] Start-up Plan [X] Conversion Plan or Start-up Plan with assets transferred from another Plan.
Plan Name. IRA Custodial Account FFN: 50143000000-007 Case: 9070037 EIN: 00-0000000 Letter Serial No: D111853b NEW ENGLAND MUTUAL LIFE INSURANCE CO. 000 XXXXXXXX XXXXXX XXXXXX, XX 00000 DEPARTMENT OF THE TREASURY
Plan Name shall be Interpath Communications, Inc. 401(k) Retirement Savings Plan.
Plan Name. None – Inducement Grant Date of Grant: [_____] Grant Type: NQSO Date of Expiration: [_____] Option Number: [___] Number Granted: [_____]