Illinois Amendment Rate Sheet Agreement between Harmony Health Plan of Illinois, Inc. and State of Illinois

Summary

This agreement outlines the capitation rates and enrollment limits for Harmony Health Plan of Illinois, Inc. to provide health services in specified Illinois regions. It sets a total enrollment cap of 250,000 members and details monthly payment rates by age, gender, and region, effective from August 1, 2006, to July 31, 2008. The agreement also specifies hospital delivery case rates and notes that only a percentage of the certified rates will be paid in the first two years. The contract is between Harmony Health Plan and the State of Illinois.

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EX-10.1 2 exhibit10-1.htm ILLINOIS AMENDMENT exhibit10-1.htm
Back to Form 8-K
Exhibit 10.1
 

ATTACHMENT I
RATE SHEETS
 
(a)
Contractor Name:
Harmony Health Plan of Illinois, Inc.
 
 
Address:
200 West Adams Street
Chicago, IL 60606
 
(b)
Contracting Arca(s) Covered by the Contractor and Enrollment Limit:

 
Contracting Area
Enrollment Limit
Region III - St. Clair, Madison, Perry,
Randolph, and Washington Counties
Jackson County (9/1/07)
Williamson County (9/1/07)
50,000
Region IV
200,000
   
 
(c)      Total Enrollment Limit for all Contracting Areas:    250,000

(e)       Standard Capitation Rates for Enrollees, effective August 1, 2006 through July 31, 2008:*


Age/Gender
Mo = month
Yr = year
Region I
(N-W, Illinois)
PMPM
Region II
(Central Illinois)
PMPM
Region III
(Southern Illinois)
PMPM
Region IV
(Cook County)
PMPM
Region V
(Collar Counties)
PMPM
0-3Mo
$1,290.99
$1 047.86
$1,214.79
$1,383.98
$1,008.88
4Mo-lYr
$122,07
$124.58
$147.56
$139.60
$131.27
2Yr-5Yr
$51.37
$55.46
$64.68
$59.00
$49.44
6Yr-13Yr
$43.52
$50.34
$55.12
$43.63
$40.03
14Yr-20Yr, Male
$75.31
$83.05
$78.87
$64.90
$82.39
14Yr-20Y, Female
$117.55
$118.15
$136.31
$100.33
$98.16
21Yr-44Yr,Male
$114.27
$136.04
$123.73
$127.39
$166.05
2 lYr-44Yr, Female
$157.98
$157.44
$166.17
$149.48
$151.36
45Yrf Male and Female
$227.11
$255.07
$256.05
$239.45
$253.90
 
* Capitation rates listed are 100% of actuarially certified rates, but only 99.5% will be paid in year one of the Contract and 99% in year two of the Contract in accordance with Section 7.8.

(f)       Hospital Delivery Case Rate, effective August 1, 2006 through July 31, 2008:

 
Hospital Delivery Case Rate (per delivery)
$3,501.90
$3,424.73
$3,591.08
$3,977.36
$3,645.96