Capitation Payments for Commercial Plan Members Sample Clauses

Capitation Payments for Commercial Plan Members. 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 *** dollars and twelve cents *** per Commercial Plan Member per month for Antelope Valley Medical Group Members and *** dollars and seventy-four cents ($***) per Commercial Plan Member per month for Sierra Medical Group Members. The Base Capitation Rate shall be adjusted for each Medical Group Member by multiplying the adjustment factor for the applicable Member by the Base Capitation Rate. Age/gender adjustment factors are actuarially determined and are listed below. Benefit adjustment factors are actuarially determined and take into consideration various co-pay and coinsurance levels. PacifiCare may modify the adjustment factors based on actuarially determined changes. Based on Medical Group Members for the month of March 2001 (without taking into account retroactive adjustments), the Medical Group’s average capitation rate would be *** per Member per month. 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:
Sample 1
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Capitation Payments for Commercial Plan Members. Capitation payments to IPA for Commercial Plan Members shall be age/sex/plan adjusted to reflect eligible Commercial Plan Members. PacifiCare shall produce age/sex/plan tables, which during the first month of the effective date of any rate change shall yield an average per member per month (“PMPM”) rate based upon the membership assigned to the applicable IPA. Effective January 1, 2001, for capitation payments to IPA for Commercial Plan, the average PMPM yield shall be ***, subject to the adjustments set forth in Article 5 of the Base Agreement and the adjustments set forth below in this Section. Effective January 1, 2002, the average PMPM yield shall be ***. PacifiCare shall disclose the yield to IPA in writing and IPA shall have the right to audit for verification. The age/sex/plan tables shall be based on an actuarial analysis by a mutually acceptable third party.
Sample 1
Capitation Payments for Commercial Plan Members. Effective January 1, 2001, Capitation Payments for Commercial Plan Members shall equal *** per Member per month, which amount shall be adjusted monthly to reflect the age/gender and play type for eligible Medical Group Members, subject to the adjustments set forth in Article 5 of the Base Agreement. Effective January 1, 2002, Capitation Payments for Commercial Plan Members shall equal *** per Member per month, which amount shall be adjusted monthly to reflect the age/gender and play type for eligible Medical Group Members, subject to the adjustments set forth in Article 5 of the Base Agreement. Age/gender and plan type adjustment will be made by multiplying the capitation rate above by age/gender and plan type factors as set forth in Exhibit 5, as modified from time to time per the term of Section 7.8.4 entitled “Amendment to Managed Care Plans.”
Sample 1
Capitation Payments for Commercial Plan Members. Capitation Payments for Commercial Plan Members shall be forty-one and thirty-four hundredths percent (41.34%) of the Commercial Plan Premium per Commercial Plan Member per month, subject to the adjustments set forth in Article 5 of the Base Agreement and the adjustments set forth below in this Section.
Sample 1
Capitation Payments for Commercial Plan Members. Capitation payments to IPA for Commercial Plan Members shall be age/sex/plan adjusted to reflect eligible Commercial Plan Members. PacifiCare shall produce age/sex/plan tables, which during the first month of the effective date of any rate change shall yield an average per member per month (“PMPM”) rate based upon the membership assigned to the applicable IPA, as of the October prior to the effective date of the applicable rate change. For capitation payments to IPA for Commercial Plan, the average PMPM yield shall be *** dollars ***, subject to the adjustments set forth in Article 5 of the Base Agreement and the adjustments set forth below in this Section. PacifiCare shall disclose the yield to IPA in writing and IPA shall have the right to audit for verification. The age/sex/plan tables shall be based on an actuarial analysis by a mutually acceptable third party.
Sample 1
Capitation Payments for Commercial Plan Members. Capitation Payments for Commercial Plan Members shall be [ ** ] of the Commercial Plan Premium per Commercial Plan Member per month, subject to the adjustments set forth in Article 5 of the Base Agreement and the adjustments set forth below in this Section.
Sample 1
Capitation Payments for Commercial Plan Members. Capitation Payments for Commercial Plan Members shall be *** of the Commercial Plan Premium per Commercial Plan Member per month, subject to the adjustments set forth in Article 5 of the Base Agreement and the adjustments set forth below in this Section. Beginnning in January, 2000, Capitation Payments shall increase ***.
Sample 1
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