Health Net 2009 Annual Report Download - page 561

Administrative Services Agreement
SCHEDULE 2.1
ADDITIONAL ADMINISTRATIVE SERVICES
Cate
g
or
y
Descri
p
tion/Activities
Transition Management Transition Management, Joint Operating Representatives
Medical Management
Prior Authorization, Concurrent Review, Case Management, Credentialing, Claims
Edits, Accreditation/Quality, Utilization Management system support
Provider Network Management
Provider Network Management, Provider Communications, Out-of-network
coordination
Health Plan & Government Programs
General Program Oversight and Regulatory Compliance, Broker Support, Data
Reconciliation, Medicare and Medicaid Sales consistent with the terms and
conditions of the Stock Purchase Agreement
Regional Health Plan Programs
Commercial Sales consistent with the terms and conditions of the Stock Purchase
Agreement, Account Management, Administration, Regulatory Affairs, Process
Improvement
Financial Planning & Analysis
Financial Planning, Reporting and Analysis
Actuary & Underwriting
Actuarial & Underwriting Services
Corporate Finance
Divisional Finance and Accounting, Accounts Payable, Payroll, Internal Audit,
Fraud & Abuse, Facilities, Procurement, Corporate Actuarial
Regulatory & External Relations
State Regulatory and Government affairs
Organization Effectiveness
Staffing, Benefits, Compensation, Associate Service Center
Legal Services & Settlements
Legal Services & Settlements
Customer Care Operations
Call Center Operations, Membership Accounting & Eligibility, Web Portal,
Customer Distribution & Mail Services, Claims, System Configuration, Appeals &
Grievances, Medicare Enrollment consistent with the terms and conditions of the
Stock Purchase Agreement
Information Technology (IT)
IT support staff, Project Management, Infrastructure and Application Support -
IBM / Cognizant contract services
Premium Taxes
Preparation and Filing of Premium Tax Returns.
Administering Post-Effective Date
Assessments
Includes fees paid for DOI 332, Health & Welfare, Individual Health Coverage,
NAIC filing fees, NJ Written Premium Assessment
Broker Commissions
Administer and process payment of Broker Commissions for Administered
Contracts consistent with the terms and conditions of the Stock Purchase
Agreement
Depreciation
Depreciation
Other Items, Corporate Admin
Insurance and Other Administrative items
The Administrative Services Agreement entered into by and among Health Net, Inc., Health Net of the Northeast, Inc., Health
Net of New Jersey, Inc., United Healthcare Services, Inc. and, solely with respect to Section 2.4(b) thereof, UnitedHealth Group
Incorporated, lists the following additional administrative service: Developing Enrollment and Eligibility Information (Category
and Description/Activities).
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