EXPERIENCE REBATE TO STATE Clause Samples

The "Experience Rebate to State" clause establishes a mechanism for returning a portion of funds or premiums to the state based on the actual experience or performance under a contract, such as lower-than-expected claims or costs. Typically, this clause applies in insurance or service agreements where the state is entitled to a rebate if the contractor's expenses fall below a predetermined threshold during the contract period. By including this provision, the clause ensures that the state benefits financially from favorable outcomes, preventing contractors from retaining excess profits and promoting cost efficiency.
EXPERIENCE REBATE TO STATE. 13.2.1 For THE CONTRACT PERIOD, HMO must pay to TDH an experience rebate calculated in accordance with the tiered rebate method listed below based on the excess of allowable HMO STAR revenues over allowable HMO STAR expenses as measured by any positive amount on Line 7 of "Part 1: Financial Summary, All Coverage Groups Combined" of the annual Managed Care Financial-Statistical Report set forth in Appendix I, as reviewed and confirmed by TDH. TDH reserves the right to have an independent audit performed to verify the information provided by HMO.
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EXPERIENCE REBATE TO STATE. 13.2.1 HMO must pay to TDH an experience rebate equal to fifty percent (50%) of the excess of allowable HMO STAR revenues over allowable HMO STAR expenses as measured by any positive amount on Line 7 of "Part 1: Financial Summary, All Coverage Groups Combined" of the annual Managed Care Financial Statistical Report set forth in Appendix I, as audited and confirmed by TDH. 13.2.2 There will be two settlements for payment of the experience rebate. The first settlement shall equal 100 percent of the experience rebate as derived from Line 7 of Part 1 (Net Income Before Taxes) of the annual Managed Care Financial Statistical (MCFS)
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EXPERIENCE REBATE TO STATE. 13.2.1 HMO must pay to HHSC an experience rebate for each Experience Rebate Period. Experience Rebate Period 1 will begin on June 1, 2004 and end on August 31, 2004, unless extended by contract amendment. The Parties may also amend the contract to include additional Experience Rebate Periods. HMO will calculate the experience rebate in accordance with the tiered rebate formula listed below based on Net Income Before Taxes (excess of allowable revenues over allowable expenses) as set forth in Appendix I. The HMO's calculations are subject to HHSC approval, and HHSC reserves the right to have an independent audit performed to verify the information provided by HMO. GRADUATED REBATE FORMULA ------------------------------------------------------------------ NET INCOME BEFORE TAXES AS A PERCENTAGE OF REVENUES HMO SHARE HHSC SHARE ------------------------------------------------------------------ 0% - 3% 100% 0% ------------------------------------------------------------------ Over 3% - 7% 75% 25% ------------------------------------------------------------------ Over 7% - 10% 50% 50% ------------------------------------------------------------------ Over 10% - 15% 25% 75% ------------------------------------------------------------------ Over 15% 0% 100% ------------------------------------------------------------------ 13.2.2 Carry Forward of Prior Experience Rebate Period Losses: Losses incurred for one Experience Rebate Period can only be carried forward as an offset to Net Income before Taxes in the next Experience Rebate Period. 13.2.2.1 HMO shall calculate the experience rebate by applying the experience rebate formula in Section 13.2. 1. For SFY 2004 the experience rebate formula will be applied to the sum of the Net Income Before Taxes for all CHIP, STAR Medicaid, and STAR+PLUS Medicaid services areas contracted between HHSC or TDHS and HMO. 13.2.3 Experience rebate will be based on a pre-tax basis. Expenses for value-added services are excluded from the determination of Net Income Before Taxes reported in the Final MCFS Report; however, HMO may subtract from Net Income Before Taxes, expenses incurred for value added services for the experience rebate calculations. 13.2.4 [THIS SUBSECTION IS INTENTIONALLY LEFT BLANK] 13.2.5 There will be two settlements for payment of the experience rebate. The first settlement shall equal 100 percent of the experience rebate as derived from Net Income Before Taxes reduced by any value-added services expenses in the fi...
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EXPERIENCE REBATE TO STATE. 13.2.1 For the contract Period. HMO must pay to TDH an experience rebate calculated in accordance with the tiered rebate method listed below based on the excess of allowable HMO STAR revenues over allowable HMO STAR expenses as measured by any positive amount on Line 7 of "Part 1: Financial Summary, All Coverage Groups Combined" of the Final Managed Care Financial Statistical Report set forth 108 Dallas Service Area Contract 115 in Appendix I, as reviewed and confirmed by TDH. TDH reserves the right to have an independent audit performed to verify the information provided by HMO. Graduated Rebate ---------------- Experience Rebate as HMO Share State Share -------------------- --------- ----------- 0% - 3% 100% 0% Over 3% - 7% 75% 25% Over 7% -10% 50% 50% Over 10% - 15% 25% 75% Over 15% 0% 100% 13.2.2 Carry Forward of Prior Contract Period Losses: Losses incurred for one contract period can only be carried forward to the next contract period. 13.2.2.1 Carry Forward of Loss from one Service Delivery Area to Another: If HMO operates in multiple Service Delivery Areas (SDAs), Losses in one SDA cannot be used to offset net income before taxes in another SDA. 13.2.3 Experience rebate will be based on a pre-tax basis.
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EXPERIENCE REBATE TO STATE. 10.6 CONTRACTOR must pay to HHSC an experience rebate for each Experience Rebate Period. CONTRACTOR will calculate the experience rebate in accordance with the tiered rebate formula listed below based on Net Income Before Taxes (excess of allowable revenues over allowable expenses) as set forth in Appendix D. The CONTRACTOR's calculations are subject to HHSC's approval, and HHSC reserves the right to have an independent audit performed to verify the information provided by CONTRACTOR. GRADUATED REBATE FORMULA ------------------------------------------------ Net Income Before Taxes as a Percentage of Total CONTRACTOR Revenues Share HHSC Share -------- ----- ---------- 0% - 3% 100% 0% Over 3% - 7% 75% 25% Over 7% - 10% 50% 50% Over 10% - 15% 25% 75% Over 15% 0% 100% Losses incurred in the 1st Experience Rebate Period may be carried forward to the 2nd and/or 3rd Experience Rate Periods for the same service area as an offset to Net Income Before Taxes in order to reduce any Experience Rebate to HHSC. Losses incurred in the 2nd Experience Rebate Period may be carried forward to the 3rd Experience Rate Period for the same service area as an offset to Net Income Before Taxes. Losses incurred in the Experience Rebate Periods subsequent to the 2nd Experience Rebate Period can only be carried forward as an offset to Net Income Before Taxes in the next Experience Rebate Period. The CONTRACTOR shall calculate the experience rebate for each period by applying the experience rebate formula as follows: For the 1st and 2nd Experience Rebate Periods, to the Net Income Before Taxes for each CHIP service area contracted between HHSC and CONTRACTOR. CONTRACTOR losses in one CHIP service area cannot be used to offset Net Income Before Taxes in another CHIP service area. For the 3rd and 4th Experience Rebate Periods, to the sum of the Net Income Before Taxes for all CHIP, STAR Medicaid, and STAR+PLUS Medicaid service areas contracted between HHSC and CONTRACTOR. Experience rebate will be based on a pre-tax basis. Expenses for value-added services are excluded from the determination of Net Income Before Taxes reported in the Annual CFS Report; however, CONTRACTOR may subtract from Net Income Before Taxes the expenses incurred for value added services for the experience rebate calculations. CONTRACTOR may subtract from an experience rebate that is owed to HHSC any expenses for population-based health initiatives that have been approved by HHSC. A population-based initiative is a ...
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Related to EXPERIENCE REBATE TO STATE

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