Vera Whole Health 6/7/2019 - Laserfiche WebLink

Clinic Year 3: the Clinic Year 2 Expected PPPM Cost multiplied by(1+Segal Health Cost Trend). 2. Calculations at End of Conditional Fee Refund Period. After the end of the Conditional Fee Refund Period,the parties will calculate the following: "Clinic Year Participants"for each Clinic Year is the sum of average monthly number of Participants for each month of the Clinic Year. For example, if Clinic Year 1 starts February 1, 2020 and the average number of Participants in February was 1500, in March was 1600, and was 1700 in each of the remaining 9 months,then the Clinic Year 1 Participants is 18400. For example, if in Clinic Year 2 the average number of Participants in January was 1500, in February was 1600, and was 1700 in each of the remaining 10 months,then Clinic Year 2 Participants is 20100. "Employer's Expected Claims Cost"for the Conditional Fee Refund Period,which is equal to the sum of:(1)the result of Clinic Year 1 Participants multiplied by Clinic Year l's Expected PPPM Cost,(2)the result of Clinic Year 2 Participants multiplied by Clinic Year 2's Expected PPPM Cost, and(3)the result of Clinic Year 3 Participants multiplied by Clinic Year 3's Expected PPPM Cost. "Employer's Actual Claims Cost"for the Conditional Fee Refund Period,which is the total of all Participant claims with date of service during the Conditional Fee Refund Period, calculated using the methodology described in Exhibit C-1 to this Schedule. "Employer's Actual Non-Claims Cost"for the Conditional Fee Refund Period,which is the sum of the following: • Total of all Reimbursable Charges for the Conditional Fee Refund Period,excluding telehealth usage fees and excluding charges for Employer-requested locums tenens coverage ; • Total of all Admin PPPM Fees for the Conditional Fee Refund Period; "Conditional Fee Refund Amount"is equal to: Employer's Actual Claims Cost minus Employer's Expected Claims Cost Schedule 2, Page 4