SHJ25-011 UNITED HEALTHCARE & KCJ Carceral 2025 Medicaid Contract - PARTIALLY EXECUTED

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agreement does not prevent the parties or their affiliates from entering into such agreements in the future. 4. Appendix 2 Definitions: Note- Certain benefit contracts defined below are defined with reference to specific identifiers on the customer identification card. Those benefit contracts may adopt a different identification card identifier in the future, and this Appendix will continue to apply to those benefit contracts; if that happens, we will provide you with information regarding the new customer identification cards. CAPITATION ARRANGEMENTS: A. Capitation arrangements are when all of the following apply: (i) You (directly or through an IPA or other provider organization in which you participate) are part of a network for one of our affiliates; and (ii) As part of that network, you arrange directly with our affiliate, or an IPA, or another medical group or other provider organization, for certain designated services to be provided to members who are assigned to you or to the IPA or the other medical group or other provider organization (as the case may be) and who are covered under benefit contracts; and under which either: (a) You are capitated or otherwise have financial responsibility; or (b) You are paid on a fee for service basis directly by the IPA, other medical group or other provider organization that has financial responsibility for the service, at a rate you have agreed upon with the IPA or other medical group or other provider organization; and (iii) You provide those designated services to one of those assigned members. In such cases, the obligation for payment will be primarily that of the IPA, medical group or other provider organization that has financial responsibility for the service, and not ours or our affiliate's. It is not a capitation arrangement when: (1) Another medical group or an IPA or other provider organization is not affiliated with you, and is capitated by Carrier for designated covered services rendered to assigned customers covered by a benefit contract issued by Carrier; and (2) You provide those designated covered services to one of those assigned customers, without having a contract or other arrangement with the other medical group or the IPA or other provider organization for the terms under which those designated covered services are provided. In such cases, this agreement will apply and the medical group or IPA or other provider organization that has responsibility for the covered service will be considered the participating entity. COMMERCIAL: B. UnitedHealtheare Navigate Benefit Contracts means benefit contracts for which the customer selects or is assigned a primary care physician to manage the customer's health care needs and referrals to network specialists, and that are marketed under one of the following names: UHCISMGA.03.12.WA Parties bound to confidentiality under Section 'About data and confidentiality' -12-