Incentive Program Withhold Clause Samples

Incentive Program Withhold. PacifiCare shall establish withholds from Medical Group’s monthly Capitation Payment for purposes of offsetting potential deficits for the combined incentive programs administered by PacifiCare, excluding the Commercial Hospital Incentive Program and the Secure Horizons Hospital Incentive Program for which separate withholds may be established. The monthly incentive withhold shall be two dollars and ninety-five cents ($2.95) per Member per month for the PacifiCare Commercial Health Plan. PacifiCare, in its sole discretion, shall prospectively adjust the withhold based on Medical Group’s experience under the combined incentive programs at the time of the program settlements described below. The monthly incentive withhold shall not exceed the amount referenced above in this paragraph.

Incentive Program Withhold. Health Plan shall establish a single withhold from Medical Group's monthly Capitation Payment for purposes of offsetting potential deficits for the combined incentive programs, excluding the Split Capitation Commercial Hospital Incentive Program and the Split Capitation Secure Horizons Hospital Incentive Program for which separate withholds may be established. The monthly incentive withhold shall initially be 0 percent (0%) of the Premium for each Managed Care Plan, as described in the applicable Product Attachment. Health Plan, in its sole discretion, shall prospectively adjust the withhold based on Medical Group's experience under the combined incentive programs at the time of the program settlements described below. In no event shall the withhold exceed 0 percent (0%) of the monthly Capitation Payment.

Incentive Program Withhold. PacifiCare shall establish a single withhold from Medical Group’s monthly Capitation Payment for purposes of offsetting potential deficits for the combined incentive programs. The monthly incentive withhold shall initially be *** per Member per month for the PacifiCare Commercial Health Plan and *** per Member per month for the Secure Horizons Health Plan. The Incentive Program Withhold shall not exceed *** per Member per month for the PacifiCare Commercial Health Plan and *** per Member per month for the Secure Horizons Health Plan. Should the Incentive Program Withhold exceed the Incentive Program Deficits, PacifiCare shall prospectively adjust the withhold on a quarterly basis, based on Medical Group’s experience under the combined incentive programs at the time of the program settlements described below. Medical Group’s Incentive Program Withhold limits, as referenced above, are based upon a calendar year. To the extent that Incentive Program Withhold amounts are decreased through the quarterly settlement process, these amounts may be subsequently increased above the stated withhold limits, provided that the average per member per month Incentive Program Withhold for the calendar year does not exceed the stated withhold limits.

Incentive Program Withhold. PacifiCare may establish and/or adjust a withhold from Medical Group’s monthly Capitation Payment for purposes of offsetting potential incentive program deficits. PacifiCare shall provide full and complete data, of which shall be in mutually agreeable data format and which calculations, including IBNR, shall consistent with industry standards and accounting principles, which demonstrates the basis of the withhold modification to the group prior to any withhold modification. The group will have thirty (30) days to review and respond to the data. At no time will the Incentive Program Withhold exceed the downside risk limit proposed, or any mutually agreed upon limit. The Incentive Program Withhold shall be refunded to the Medical Group at the time of the incentive program settlements, except that Medical Group’s share of any incentive program deficits shall be deducted from such refund. As of the date of this Agreement, it is understood that the withhold for Secure Horizons is set at *** PMPM; and the withhold for PacifiCare Commercial and Commercial POS is ***. Effective January 1, 2002, the withhold for PacifiCare Commercial and Commercial POS is set at ***.

Incentive Program Withhold. PacifiCare shall establish a single withhold from Medical Group’s monthly Capitation Payment for purposes of offsetting potential deficits for the combined incentive programs. The monthly incentive withhold shall initially be one dollar ($1.00) per Member per month for the PacifiCare Commercial Health Plan and five percent (5%) for the Secure Horizons Health Plan. PacifiCare, in its sole discretion, shall prospectively adjust the withhold based on Medical Group’s experience under the combined incentive programs at the time of the program settlements described below.

Incentive Program Withhold. PacifiCare may establish and/or adjust a withhold from Medical Group’s monthly Capitation Payment for purposes of offsetting potential incentive program deficits. PacifiCare shall provide full and complete data, of which shall be in mutually agreeable format and which calculations, including IBNR, shall be consistent with industry standards and accounting principles, which demonstrates the basis of the withhold modification to the group prior to any withhold modification. The group will have thirty (30) days to review and respond to the data. At no time will the Incentive Program Withhold exceed the downside risk limit proposed, or any mutually agreed upon limit. The Incentive Program Withhold shall be refunded to the Medical Group at the time of the incentive program settlements, except that Medical Group’s share of any incentive program deficits shall be deducted from such refund. As of the date of this Agreement, it is understood that the withhold is set at zero percent (0%).

Incentive Program Withhold. PacifiCare shall establish withholds from Medical Group’s monthly Capitation Payment for purposes of offsetting potential deficits for the combined incentive programs administered by PacifiCare, excluding the Commercial Hospital Incentive Program and the Secure Horizons Hospital Incentive Program for which separate withholds may be established. The monthly incentive withhold shall be one dollar and fifty cents ($1.50) per Member per month for the ▇▇▇▇▇▇▇ Oaks network and Corona network for the PacifiCare Commercial Health Plan. The monthly incentive withhold shall initially be twenty-five dollars ($25.00) per Member per month for the Secure Horizons Health Plan. Based on quarterly settlement results, PacifiCare will have the ability to increase the withhold to a maximum of thirty dollars ($30.00) per Member per month for the Secure Horizons Health Plan. However, this increase shall not be made prior to June 30, 2003. PacifiCare, in its sole discretion, shall prospectively adjust the withhold based on Medical Group’s experience under the combined incentive programs at the time of the program settlements described below. The monthly incentive withholds shall not exceed the amounts referenced above in this paragraph.

Incentive Program Withhold. PacifiCare shall establish withholds from Medical Group’s monthly Capitation Payment for purposes of offsetting potential deficits for the combined incentive programs administered by PacifiCare, excluding the Commercial Hospital Incentive Program and the Secure Horizons Hospital Incentive Program for which separate withholds may be established. The monthly incentive withhold shall be one dollar and fifty cents ($1.50) per Member per month for the ▇▇▇▇▇▇▇ Oaks network and Corona network for the PacifiCare Commercial Health Plan. The monthly incentive withhold shall initially be twenty-five dollars ($25.00) per Member per month for the Secure Horizons Health Plan. Based on quarterly settlement results, PacifiCare will have the ability to increase the withhold to a maximum of thirty dollars ($30.00) per Member per month for the Secure Horizons Health Plan. However, this increase shall not be made prior to June 30, 2003. PacifiCare, in its sole discretion, shall prospectively adjust the withhold based on Medical Group’s experience under the combined incentive programs at the time of the program settlements described below. The monthly incentive withholds shall not exceed the amounts referenced above in this paragraph.