categories for the duration of the Contract period, except as provided in Section 4.8.C. below. The Contractor shall submit to EOHHS for its prior approval, the reinsurance policy documenting the type and scope of coverage, and the estimated cost of purchasing the private reinsurance policy. Such documentation must be submitted to EOHHS no later than 45 days, or another date specified by EOHHS, prior to the effective date of purchase or renewal of the reinsurance policy. Self-Insurance The Contractor may choose self-insurance in lieu of private reinsurance if the Contractor meets the solvency standards imposed on HMOs by the DOI described in Section 2.15.E.1. If the Contractor chooses self-insurance pursuant to this Section 4.8.C, the Contractor shall: Maintain a separate restricted reserve fund equal to 8.5% of the amount equal to 60 days of the capitation payment revenue, or Contractor’s another amount determined sufficient by EOHHS, for the purpose of covering medical claims for Enrollees, and maintain this separate restricted reserve fund in a restricted reserve account; Submit to EOHHS, on a quarterly basis, and in a form and format specified by EOHHS, documentation of compliance with the requirements described in subsection 1. above; and; Inform EOHHS, in writing, and in a form and format specified by EOHHS, of the amount of the total expenditures from the restricted reserve account no later than 270 days after the end of each Contract Year. CBHI Services Risk Corridors and Reconciliation Process for Contract Year 2018 For RC I Child and RC II Child, the Contractor and EOHHS shall share risk for CBHI Services in accordance with the following provisions: For Contract Year 2018, once the reconciliation set forth in Section 4.3.D is completed, EOHHS shall conduct a separate reconciliation with respect to CBHI Services, as follows: EOHHS will first determine the amount paid to the Contractor by EOHHS for CBHI Services for Contract Year 2018 by multiplying the following: The CBHI Add-On to the applicable Risk Adjusted Capitation Rates, which shall be determined by EOHHS and provided to the Contactor in Appendix D; by
categories for the duration of the Contract period, except as provided in Section 4.8.C. below. The Contractor shall submit to EOHHS for its prior approval, the reinsurance policy documenting the type and scope of coverage, and the estimated cost of purchasing the private reinsurance policy. Such documentation must be submitted to EOHHS no later than 45 days, or another date specified by EOHHS, prior to the effective date of purchase or renewal of the reinsurance policy. Self-Insurance The Contractor may choose self-insurance in lieu of private reinsurance if the Contractor meets the solvency standards imposed on HMOs by the DOI described in Section 2.15.E.1. If the Contractor chooses self-insurance pursuant to this Section 4.8.C, the Contractor shall: Maintain a separate restricted reserve fund equal to 8.5% of the amount equal to 60 days of the Contractor’s capitation payment revenue, or another amount determined sufficient by EOHHS, for the purpose of covering medical claims for Enrollees, and maintain this separate restricted reserve fund in a restricted reserve account; Submit to EOHHS, on a quarterly basis, and in a form and format specified by EOHHS, documentation of compliance with the requirements described in subsection 1. above; and; Inform EOHHS, in writing, and in a form and format specified by EOHHS, of the amount of the total expenditures from the restricted reserve account no later than 270 days after the end of each Contract Year. CBHI Services Risk Corridors and Reconciliation Process for Contract Year 2018 For RC I Child and RC II Child, the Contractor and EOHHS shall share risk for CBHI Services in accordance with the following provisions: For Contract Year 2018, once the reconciliation set forth in Section 4.3.D is completed, EOHHS shall conduct a separate reconciliation with respect to CBHI Services, as follows: EOHHS will first determine the amount paid to the Contractor by EOHHS for CBHI Services for Contract Year 2018 by multiplying the following: The CBHI Add-On to the applicable Risk Adjusted Capitation Rates, which shall be determined by EOHHS and provided to the Contactor in Appendix D; by