Health Net 2009 Annual Report Download - page 520

“Management Functions” means any function for which the Company may contract only with the approval of an applicable
Governmental Entity, including (1) maintenance of the Books and Records; (2) disposition of assets and incurrence of liabilities
normally associated with the day to day operations of the Company; (3) implementation of policies affecting the delivery of health
care services; (4) Claims payment; (5) implementation of the Company’s budgets and provision for annual audits; (6) quality
assurance and improvement activities; (7) any utilization review activity; and (8) investigation of cases of suspected fraudulent and
abusive activity and fraud and abuse prevention and reduction activities under the Company’s fraud and abuse prevention plan.
“Material Subcontract” shall have the meaning set forth in Section 3.4.
“Medicaid Business” means the Company’s business of providing services to individuals who receive their coverage under the
Company’s Medicaid Plan Contract.
“Medicaid Plan Contract” means the Agreement to Provide HMO Services between Health Net of New Jersey, Inc. and the State
of New Jersey, Department of Human Services, Division of Medical Assistance and Health Services (DMAHS), effective October 1,
2000, as amended.
“Medical Management Programs” shall have the meaning set forth in Section 8.4.
“Medicare Business” means the Company’s business of providing services to groups and individuals who receive their coverage
under the Company’s Medicare Plan Contracts.
“Medicare Plan Contracts” means the following contracts: (i) Contract Number H0755 between Health Net of Connecticut, Inc.
and CMS and (ii) Contract Number H5721 between Health Net Insurance of New York, Inc. and CMS, in each case, including any
renewals of such contract[s] through the Expiration Date, and (iii) the Joint Medicare PDP Contract, solely to the extent applicable to
Medicare Part D plan members in New York sponsored by Health Net Insurance of New York, Inc.
“Monthly Accountings” shall have the meaning set forth in Section 10.4
“Monthly Compliance Report” shall have the meaning set forth in Section 3.1(d).
“Monthly Premium-By-State Report” shall have the meaning set forth in Section 10.3(a).
“Monthly Premium Tax Accounting” shall have the meaning set forth in Section 10.4.
“Nonpublic Personal Information” shall have that meaning set forth in Section 13.3(a).
“NY Medicare PDP Members” shall have the meaning set forth in Section 9.3.
“Parent” shall have the meaning set forth in the preamble of this Administrative Services Agreement.
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