Health Net 2009 Annual Report Download - page 543

(c) [Administrator will provide annual reports on its financial operations to Company and, upon request, any operational
data requested by Company, the Commissioner of the New York State Department of Health, or the Superintendent of the New York
State Department of Insurance.]
Section 10.3. Monthly Reports. Subject to Section 10.3(e) below, as soon as available and in no event later than fifteen
(15) Business Days after the end of each calendar month, the Administrator shall prepare and submit to the Company a report in the
form attached as Schedule 10.3 setting forth the following information:
(a) all (i) Premium paid, earned and unearned, and unpaid for such month, (ii) Claims reported, paid, denied and open, and
any capitation payments made, during such month, Claims previously reported and still open and claims previously reported and
closed, each on a product level basis (e.g., commercial, Medicare, Medicaid), and (iii) Commissions paid and earned during such
month;
(b) the billed Premium by state with respect to the Insurance/HMO Contracts and the Renewal Contracts for such month
(the “Monthly Premium-By-State Report”), accompanied by supporting records as the Company or its auditors shall reasonably
request;
(c) a written statement of accounting in the form attached as Schedule 10.3(c) (each, an “Health Assessments Monthly
Accounting”) setting forth amounts assessed with respect to insolvency funds and guarantee assessments, CHIP assessments,
NYHCRA surcharges and NY Insurance Department, Regulation 146 assessments, covered lives assessments and other health related
assessments for high-risk pools, reinsurance pools and other similar pools against or payable by the Company on a reported and
restated basis (collectively, the “Post-Effective Date Assessments”);
(d) the amount of actuarial Claims reserves that the Company calculates on a monthly basis with respect to the
Insurance/HMO Contracts, consistent with the Company’s past practices in effect immediately prior the Effective Date (excluding
various adjustments and calculations to be made on a quarterly basis in connection with preparing and submitting the Company’s
quarterly statutory financial statements), accompanied by such supporting records as shall be reasonably sufficient to indicate how
reserves have been calculated. In addition, the Administrator shall indicate any material changes in the reserve methodology used by
the Administrator in calculating statutory reserves for the Insurance/HMO Contracts and the Renewal Contracts;
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This provision is found only in the Administrative Services Agreement of Health Net of New York, Inc.
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