Age/Gender/Benefit Adjusted Commercial Capitation Sample Clauses

Age/Gender/Benefit Adjusted Commercial Capitation. Capitation
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Age/Gender/Benefit Adjusted Commercial Capitation. Capitation Payments for Commercial Plan Members shall be made based upon a per Member per month base capitation rate (“Base Capitation Rate”) adjusted to reflect the Medical Group Members’ age, gender, and benefit plan participation. For 2003, the Base Capitation Rate shall be *** per Commercial Plan Member per month. Age/gender adjustment factors are actuarially determined and are listed below. Benefit adjustment factors are actuarially determined and may take into consideration variations in benefit plan types, Copayment and coinsurance levels. PacifiCare may change its benefit adjustment factors as needed to support the differing plan types that it offers. On an annual basis, PacifiCare may modify the benefit adjustment factors based on actuarially determined changes. The Standard Service Capitation Amount will vary during subsequent months as a result of changes in the age, gender, and benefit plan participation of the Medical Group’s Members for the applicable month. The total monthly Capitation Payment shall also be adjusted in the manner set forth in Article 5 of the Base Agreement. The following are PacifiCare’s age gender adjustment factors:
Sample 1
Age/Gender/Benefit Adjusted Commercial Capitation. Capitation Payments for Commercial Plan Members shall be made based upon a per Member per month base capitation rate (“Base Capitation Rate”) adjusted to reflect the Medical Group Members’ age, gender, and benefit plan participation. The Base Capitation Rate for both Gateway Physicians-United Western Medical Center (DEC 16210) and Gateway Physicians-Placentia Xxxxx (DEC 16206) shall be *** per Commercial Plan Member per month. Age gender adjustment factors are actuarially determined and arc listed below. Benefit adjustment factors are actuarially determined by PacifiCare and may take into consideration variations in benefit plan types, Copayment and coinsurance levels. PacifiCare may change its benefit adjustment factors as needed to support the differing plan types that it offers. On an annual basis, PacifiCare may modify the benefit adjustment factors based on actuarially determined changes. The Standard Service Capitation Amount will vary during subsequent months as a result of changes in the age, gender, and benefit plan participation of the Medical Group’s Members for the applicable month. The total monthly Capitation Payment shall also be adjusted in the manner set forth in Article 5 of the Base Agreement. The following are PacifiCare’s age/gender adjustment factors Gender Age Band Physician C 00-00 1.8412 C 01-01 1.1116 C 02-09 0.4434 C 10-17 0.4411 F 18-19 0.6649 F 20-24 0.9544 F 25-29 1.3620 F 30-34 1.3911 F 35-39 1.3147 F 40-44 1.3872 F 45-49 1.5017 F 50-54 1.7097 F 55-59 1.9981 F 60-64 2.2818 F 65 and Over 1.9375 M 18-19 0.3840 M 20-24 0.3787 M 25-29 0.4805 M 30-34 0.6052 M 35-39 0.6675 M 40-44 0.8186 M 45-49 1.0095 M 50-54 1.3110 M 55-59 1.7451 M 60-64 2.1970 M 65 and Over 2.0813
Sample 1
Age/Gender/Benefit Adjusted Commercial Capitation. Capitation Payments for Commercial Plan Members shall be made based upon a per Member per month base capitation rate (“Base Capitation Rate”) adjusted to reflect the Medical Group Members’ age, gender, and benefit plan participation. Effective January 1, 2003, the Base Capitation Rate for Sierra Medical Group (PacifiCare Dec # 2351) shall be *** per Commercial Plan Member per month. The Base Capitation Rate for Antelope Valley IPA (PacifiCare Dec # 5185) shall be *** per Commercial Plan Member per month. Effective- January 1, 2004, the Base Capitation Rate for Sierra Medical Group (PacifiCare Dec # 2351) shall be *** per Commercial Plan Member per month. The Base Capitation Rate for Antelope Valley IPA (PacifiCare Dec # 5185) shall *** per Commercial Plan Member per month. Age/gender adjustment factors are actuarially determined and are listed below. Benefit adjustment factors are actuarially determined by PacifiCare and may take into consideration variations in benefit plan types, Copayment and coinsurance levels. PacifiCare may change its benefit adjustment factors as needed to support the differing plan types that it offers. On an annual basis, PacifiCare may modify the benefit adjustment factors based on actuarially determined changes. The Standard Service Capitation Amount will vary during subsequent months as a result of changes in the age, gender, and benefit plan participation of the Medical Group’s Members for the applicable month. The total monthly Capitation Payment shall also be adjusted in the manner set forth in Article 5 of the Base Agreement. The following are PacifiCare’s age/gender adjustment factors:
Sample 1
Age/Gender/Benefit Adjusted Commercial Capitation. Capitation Payments for Commercial Plan Members shall be made based upon a per Member per month base capitation rate (“Base Capitation Rate”) adjusted to reflect the Medical Group Members’ age, gender, and benefit plan participation. The Base Capitation Rate shall be *** per Commercial Plan Member per month. Age/gender adjustment factors are actuarially determined and are listed below. Benefit adjustment factors are actuarially determined and may take into consideration variations in benefit plan types, copay and coinsurance levels. PacifiCare may change its benefit adjustment factors as needed to support the differing plan types that it offers. On an annual basis, PacifiCare may modify the benefit adjustment factors based on actuarially determined changes. The average capitation rate will vary during subsequent months as a result of changes in the age, gender, and benefit plan participation of the Medical Group’s Members for the applicable month. The total monthly Capitation Payment shall also be adjusted in the manner set forth in Article 5 of the Base Agreement. The following are PacifiCare’s age/gender adjustment factors: Age Sex Category Age/Sex Factor Child 0 1.9939 Child 1 1.2664 Child 2-9 0.4730 Child 10-17 0.4375 Female 18-19 0.7395 Female 20-24 1.4564 Female 25-29 1 6593 Female 30-34 1.4785 Female 35-39 1.2495 Female 40-44 1.3095 Female 45-49 1.2221 Female 50-54 1.5869 Female 55-59 1.7404 Female 60-64 2.0135 Female 65 plus 2.0630 Male 18-19 0.3554 Male 20-24 0.4774 Male 25-29 0.5702 Male 30-34 0.6033 Male 35-39 0.7038 Male 40-44 0.7700 Male 45-49 0.8742 Male 50-54 1.3235 Male 55-59 1.7024 Male 60-64 2.2284 Male 65 plus 2.3563
Sample 1

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