Gatekeeper Program definition

Gatekeeper Program means (i) a product that includes fully insured Standard HMO, Point of Service, or Gatekkeper PPO benefits and which is underwritten by a licensed insurance company based on an experience rating methodology, or (ii) a self funded product which includes Standard HMO, Point of Service, or Gatekeeper PPO benefits. This definition includes, but is not limited to, Participants covered under Flexcare plans insured/administered by Connecticut Life Insurance Company. -------------------------------------------------------------------------------------------- Gentiva Homehealth Infusion and DME/HME Capitation Rate PMPM -------------------------------------------------------------------------------------------- All Commercial HMO Capitated Affiliates * -------------------------------------------------------------------------------------------- Capitation Rate Compensation Terms ---------------------------------- The following rates are established for the provision of Home Care Services rendered to Program Participants covered under the HMO and Gatekeeper plans: February 1, 2006 - January 31, 2007 $* per member per month February 1, 2007 - January 31, 2008 $* per member per month February 1, 2008 - January 31, 2009 $* per member per month The capitation rate listed above will be allocated between HMO and Gatekeeper Program participants in accordance with established business practices. On or about December 1 of each year, the parties shall reconcile the allocation and settle any payment difference no later than December 31 of each calendar year. If an outlier calculation for * demonstrates a patient per thousand (PPK) increase in excess of *, (* ppk), then MCA reserves the right to propose an * pmpm outlier adjustment. CIGNA may elect to accept this adjustment or * and * from this agreement. *Confidential treatment requested. EXHIBIT A HMO PROGRAM ATTACHMENT - CAPITATION SCHEDULE OF CAPITATION RATES CAPITATION RATES EFFECTIVE 2/1/06 - 1/31/07
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Gatekeeper Program means (i) a product that includes fully insured Standard HMO, Point of Service, or Gatekeeper PPO benefits and which is underwritten by a licensed insurance company based on an experience rating methodology, or (ii) a self funded product which includes Standard HMO, Point of Service, or Gatekeeper PPO benefits. This definition includes, but is not limited to, Participants covered under FlexCare plans insured/administered by Connecticut General Life Insurance Company. All Gatekeeper (FlexCare) Capitated Affiliates ***
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Gatekeeper Program means (i) a product that includes fully insured Standard HMO, Point of Service, or Gatekkeper PPO benefits and which is underwritten by a licensed insurance company based on an experience rating methodology, or (ii) a self funded product which includes Standard HMO, Point of Service, or Gatekeeper PPO benefits. This definition includes, but is not limited to, Participants covered under Flexcare plans insured/administered by Connecticut Life Insurance Company. Gentiva Homehealth Infusion and DME/HME Capitation Rate PMPM ----------- All Commercial HMO Capitated Affiliates EXHIBIT A GATEKEEPER PROGRAM ATTACHMENT - FEE FOR SERVICE REIMBURSEMENT FOR OTHER SERVICES RATE AREA DESIGNATIONS: STATE RATE AREA RATE DESIGNATION -------------------------------------------------------------------- Alabama * * Alaska * * Arizona * * Arkansas * * California * * Colorado * * Connecticut * * Delaware * * District of Columbia * * Florida * * Georgia * * Hawaii * * Idaho * * Illinois * * Indiana * * Iowa * * Kansas * * Kentucky * * Louisiana * * Maine * * Maryland * * Massachusetts * * Michigan * * Minnesota * * Mississippi * * Missouri * * Montana * * Nebraska * * Nevada * * New Hampshire * * New Jersey * * New Mexico * * New York * * North Carolina * * North Dakota * * Ohio * * Oklahoma * * Oregon * * Pennsylvania * * Rhode Island * * South Carolina * * South Dakota * * Tennessee * * Texas * * Utah * * Vermont * * Virginia * * Washington * * West Virginia * * Wisconsin * * Wyoming * * * Confidential Treatment Requested TRADITIONAL HOME HEALTH FEE-FOR-SERVICE RATE RATES EFFECTIVE JANUARY 1, 2005 - DECEMBER 31, 2005 THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE BOTH VISIT AND HOURLY RATES. Notes 1, 2, 3, 4, 5 and 6 apply
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Examples of Gatekeeper Program in a sentence

  • A "Gatekeeper Program" means (i) a product that includes fully insured Standard HMO, Point of Service, or Gatekeeper PPO benefits and which is underwritten by a licensed insurance company based on an experience rating methodology, or (ii) a self funded product which includes Standard HMO, Point of Service, or Gatekeeper PPO benefits.

  • The following rates are established for the provision of Home Care Services rendered to Program Participants covered under the HMO and Gatekeeper plans: The capitation rate listed above will be allocated between HMO and Gatekeeper Program participants in accordance with established business practices.

  • The following rates are established for the provision of Home Care Services rendered to Program Participants covered under the HMO and Gatekeeper plans: February 1, 2008 - January 31, 2009 *** per member per month February 1, 2009 - January 31, 2010 *** per member per month February 1, 2010 - January 31, 2011 *** per member per month The capitation rate listed above will be allocated between HMO and Gatekeeper Program particiants in accordance with established business practices.

  • The NE CAP PMPM rate will be allocated among the existing HMO Program and Gatekeeper Program membership based on the weighted average of membership within each Program.

  • The following rates are established for the provision of Home Care Services rendered to Program Participants covered under the HMO and Gatekeeper plans: February 1, 2008 - January 31, 2009 *** per member per month February 1, 2009 - January 31, 2010 *** per member per month February 1, 2010 - January 31, 2011 *** per member per month The capitation rate listed avove will be allocated between HMO and Gatekeeper Program particiants in accordance with established business practices.

  • Notwithstanding the capitation rate set forth in the Agreement, should the Baseline PMPM as calculated in Section C below entitled "Baseline PMPM Rate" be below * PMPM, then the capitation rate for CIGNA New England HMO Program and Gatekeeper Program Participants will be the Baseline PMPM as defined *Confidential Treatment Requested and calculated in Section C below * (the "NE CAP PMPM") per member per month effective July 1, 2005.

  • CIGNA and MCA agree to Amend the Agreement under: (1) Exhibit A to the HMO Program Attachment - Fee For Service, Reimbursement For Other Services, Rate Area Designations; (2) Exhibit A to the PPO & Indemnity Program Attachment, Reimbursement For Other Services, Rate Area Designations; and (3) Exhibit A to Gatekeeper Program Attachment - Fee For Service, Reimbursement For Other Services, Rate Area Designations to identify Massachusetts and Rhode Island as Rate Area and Rate Designation*.