Monthly Premium Payment Calculation Clause Samples

Monthly Premium Payment Calculation. ‌ The monthly premium payment for each enrollee will be calculated as follows: Additional premium payments include Delivery Case Rates, Low Birth Weight Baby Case Rates and Supplemental Premium Payments, as described in Subsections 5.7 through 5.9 of this Contract. 5.2.1 The Statewide Base Rate will be established by HCA and will vary between the Apple Health Family (AH Family), Apple Health Blind Disabled (AHBD) and Apple Health Adult Coverage – Medicaid Expansion (AHME) populations. The base rates will initially be the same for all contractors, but may vary based on ACA related taxes and/or fees. 5.2.2 The Age/Sex Adjustment factors will be established by HCA and will vary between the AH Family, AHBD and AHME populations. The age/sex factors will be the same for all contractors. 5.2.3 The Geographical Adjustment Factors will be recalculated by HCA annually to reflect changes in the relative cost of providing care in different geographical areas of the State. The Geographical Adjustment Factors and geographic service areas are the same for all contractors but may vary between AH Family, AHBD and AHME populations. 5.2.4 For the period of January 1, 2014 through January 31, 2014, the Risk Adjustment Factors will be as established for the rates effective January 1, 2014 by HCA for the Apple Health Family (“AH Family”) population and the AH Blind and Disabled (“AHBD”) population to reflect differences in the relative health status of the populations enrolled with the Contractors. The Risk Adjustment Factors are calculated by geographical region and by Contractor. 5.2.5 By February 1, 2014, HCA will make a retroactive update to the Risk Adjustment Factors for the AH Family and AHBD populations that were in place effective January 1, 2014. The data collection and calculation method for this adjustment is as follows: 5.2.5.1 The Contractor will provide updated encounter data for SFY 2013 with run-out through October 2013 to an actuary designated by HCA by January 1, 2014. 5.2.5.2 The actuary will collect FFS data and encounter data for other Medicaid managed care programs from HCA for the same period. 5.2.5.3 The actuary will re-compute all risk scores based upon the most recently available enrollment data provided by HCA, the FFS data and additional managed care data provided by HCA, and the updated encounter data provided by the Contractor. 5.2.5.4 The risk score calculation will include historical data for all RAC codes for the enrollees present in the Contra...
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Monthly Premium Payment Calculation. The monthly premium payment for each enrollee will be calculated as follows: Additional premium payments are made for Delivery Case Payment Rates as described in Subsection 5.6 of this Contract.
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Monthly Premium Payment Calculation. 5.2.1 The capitation rates are identified and developed, and payment is made in accordance with generally accepted actuarial principles and practices. 5.2.1.1 The Behavioral Health component of the capitation rate is based on services provided by DOH licensed Behavioral Health Agencies as described on Exhibit I. 5.2.2 The monthly premium payment for each Enrollee under this Contract will equal the capitation rates for each age band. 5.2.2.1 Premium Payment = Capitation Rate (at the age cell level) 5.2.3 Additional premium payments include Wraparound with Intensive Services (WISe), and New Journeys as described in the WISe Payment, and New Journeys subsections in this Contract. 5.2.4 The premium payment formula is established by HCA and will vary between age bands within the AHE population. The base rates will be the same for all Contractors. Risk adjustment and withhold factors will not be applied during the initial program year. 5.2.5 HCA shall make a full monthly payment to the Contractor for the month in which an Enrollee's enrollment is terminated except as otherwise provided in this Contract.
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Related to Monthly Premium Payment Calculation

  • Payment Calculation District shall pay Contractor at a rate of $ per . District shall pay Contractor as described in attached Exhibit A

  • Monthly Payment City shall make monthly payments, based on invoices received, for services satisfactorily performed, and for authorized reimbursable costs incurred. City shall have 30 days from the receipt of an invoice that complies with all of the requirements above to pay Consultant.

  • Payment Due Date Unless City notifies the Contractor that a dispute exists, Payment shall be made within [Enter number of days, generally ≥ 30] calendar days, measured from (1) the delivery of goods and/or the rendering of services or (2) the date of receipt of the invoice, whichever is later. Payment is deemed to be made on the date on which City has issued a check to Contractor or, if Contractor has agreed to electronic payment, the date on which City has posted electronic payment to Contractor.

  • Premium Payment The Bank shall pay any premiums due on the Policy.

  • Interim payment At the end of each of the periods indicated in Annex I the Contractor shall submit to the Agency a formal request for payment accompanied by those of the following documents which are provided for in the Special Conditions: ➢ an interim technical report in accordance with the instructions laid down in ▇▇▇▇▇ ▇; ➢ the relevant invoices indicating the reference number of the Contract and of the order or specific contract to which they refer;