Medical Loss Ratio Limitation Sample Clauses

Medical Loss Ratio Limitation. The Contractor medical loss ratio for each program is limited to eighty-five percent (85%) in calendar year 2013. Medical loss ratio shall be as defined by the Office of the Insurance Commissioner (OIC) in RCW 48.43.049 with the additional inclusion of any quality incentive payments made directly to Participating Providers prior to the end of the year. If the Contractor’s actual medical loss ratio as determined by HCA and its actuaries using the Contractor’s financial information, is less than eighty-three percent (83%), HCA will calculate an amount due from the Contractor by subtracting the Contractor’s actual medical loss ratio related to its performance under this Contract in the calendar year from eighty-three percent (83%) and multiplying the result by the total premiums paid to the Contractor for the calendar year, including the Delivery Case Rate. The Contractor shall remit to HCA the amount due within ninety (90) calendar days of the date that HCA provides notice to the Contractor of that amount. This provision shall survive the expiration or termination of this Contract.
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