Common use of CHIP Budget Clause in Contracts

CHIP Budget. The CHIP Budget for Commercial Plan Members shall be established based upon a per Member per month rate (“Base Rate”) adjusted to reflect the Assigned Medical Group Members’ age, gender, and benefit plan participation. The Base Rate for both Gateway Physicians-United Western Medical Center (DEC 16210) and Gateway Physicians-Placentia ▇▇▇▇▇ (DEC 16206) shall be *** per Commercial Plan Member per month. Age/gender adjustment factors are actuarially determined by PacifiCare and are listed below. Benefit adjustment factors are actuarially determined by PacifiCare and 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 CHIP Budget will vary during subsequent months as a result of changes in the age, gender, and benefit plan participation of the Assigned Medical Group Members for the applicable month. The following are PacifiCare’s CHIP Budget age/gender adjustment factors: C 00-00 4.0488 C 01-01 0.7234 C 02-09 0.3228 C 10-17 0.3706 F 18-19 0.5841 F 20-24 0.9398 F 25-29 1.4088 F 30-34 1.3551 F 35-39 1.1025 F 40-44 1.0464 F 45-49 1.1741 F 50-54 1.4581 F 55-59 2.0324 F 60-64 2.4463 F 65 and Over 2.2225 M 18-19 0.4431 M 20-24 0.4520 M 25-29 0.5000 M 30-34 0.5081 M 35-39 0.6558 M 40-44 0.8823 M 45-49 1.1058 M 50-54 1.5844 M 55-59 2.2785 M 60-64 3.0045 M 65 and Over 2.9368

CHIP Budget. The CHIP Budget for Commercial Plan Members shall be established based upon a per Member per month rate (“Base Rate”) adjusted to reflect the Assigned Medical Group Members’ age, gender, and benefit plan participation. The Base Rate for both Gateway Physicians-United Western Medical Center (DEC 16210) and Gateway Physicians-Placentia ▇▇▇▇▇ (DEC 16206) shall be *** (***) per Commercial Plan Member per month. Age/gender adjustment factors are actuarially determined by PacifiCare and are listed below. Benefit adjustment factors are actuarially determined by PacifiCare and 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 CHIP Budget will vary during subsequent months as a result of changes in the age, gender, and benefit plan participation of the Assigned Medical Group Members for the applicable month. The following are PacifiCare’s CHIP Budget age/gender adjustment factors: C 00-00 4.0488 C 01-01 0.7234 C 02-09 0.3228 C 10-17 0.3706 F 18-19 0.5841 F 20-24 0.9398 F 25-29 1.4088 F 30-34 1.3551 F 35-39 1.1025 F 40-44 1.0464 F 45-49 1.1741 F 50-54 1.4581 F 55-59 2.0324 F 60-64 2.4463 F 65 and Over 2.2225 M 18-19 0.4431 M 20-24 0.4520 M 25-29 0.5000 M 30-34 0.5081 M 35-39 0.6558 M 40-44 0.8823 M 45-49 1.1058 M 50-54 1.5844 M 55-59 2.2785 M 60-64 3.0045 M 65 and Over 2.9368