AMENDED AND RESTATED CONTRACT

Insurance Agreement

You are currently viewing:

This Insurance Agreement involves

AMERIGROUP CORP | AMERIGROUP NEW JERSEY, INC | AGREEMENT TO PROVIDE HMO SERVICES | DEPARTMENT OF HUMAN SERVICES

. RealDealDocs™ contains millions of easily searchable legal documents and clauses from top law firms. Search for free - click here.

Title: AMENDED AND RESTATED CONTRACT
Date: 3/9/2004
Industry: INSACC

Search Insurance Agreement by:

exv10w6w2

Exhibit 10.6.2

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES

AND

AMERIGROUP NEW JERSEY, INC.

AGREEMENT TO PROVIDE HMO SERVICES

In accordance with Article 7, section 7.11.2A and 7.11.2B of the contract between AMERIGROUP New Jersey, Inc. and the State of New Jersey, Department of Human Services, Division of Medical Assistance and Health Services (DMAHS), effective date October 1, 2000, all parties agree that certain sections of the contract shall be amended to be effective October 1, 2003, as follows:

NJ FamilyCare Extension - October 1, 2003

Article 1, “Definitions” section - for the following definition:

• NJ FamilyCare Plan H

shall be amended as reflected in the relevant pages of Article 1 attached hereto and incorporated herein.

2.		Article 8, “Financial Provisions,” Sections 8.5.1 and 8.7(F)4 shall be amended as reflected in Article 8, Sections 8.5.1 and 8.7(F)4 attached hereto and incorporated herein.

3.		Appendix, Section C, “Capitation Rates,” shall be revised as reflected in SFY 2004 Capitation Rates attached hereto and incorporated herein.

NJ FamilyCare Extension -October 1, 2003

All other terms and conditions of the October 1, 2000 contract and subsequent amendments remain unchanged except as noted above.

The contracting parties indicate their agreement by their signatures.


AMERIGROUP	State of New Jersey
New Jersey, Inc.	Department of Human Services

BY: /s/ Norine Yukon	BY:

		Matthew D. D’Oria

TITLE: President & CEO	TITLE:	Acting Director, DMAHS

DATE: August 27, 2003	DATE

APPROVED AS TO FORM ONLY

Attorney General State

of New Jersey


BY:

		Deputy Attorney General

DATE:

NJ FamilyCare Plan D—means the State-operated program which provides managed care coverage to uninsured:

Parents/caretakers with children below the age of 19 who do not qualify for AFDC Medicaid with family incomes up to and including 200 percent of the federal poverty level; and
Parents/caretakers with children below the age of 23 years and children from the age of 19 through 22 years who are full time students who do not qualify for AFDC Medicaid with family incomes up to and including 250 percent of the federal poverty level; and Children below the age of 19 with family incomes between 201 percent and up to and including 350 percent of the federal poverty level.

Eligibles with =incomes above 150 percent of the federal poverty level are required to participate in cost sharing in the form of monthly premiums and copayments for most services with the exception of both Eskimos and Native American Indians under the age of 19 years. These groups are identified by-Program Status Codes (PSCs) or Race Code on the eligibility system as indicated below. For clarity, the Program Status Codes or Race Code, in the case of Eskimos and Native American Indians under the aj; ‘of 19 years, related to Plan D non-cost sharing groups are also listed.


PSC	PSC		Race Code
Cost Sharing	No Cost Sharing		No Cost Sharing

301		300		3
493		380
494		497
495
498

In addition to covered managed care services, eligibles under these programs may access certain services which are paid fee-for-service and not covered under this contract.

NJ FamilyCare Plan H-means the State-operated program which provides managed care administrative services coverage to uninsured:


	Adults and couples without dependent children under the age of 19 with family incomes up to and including 100 percent of the federal poverty level; Adults and couples without dependent children under the age of 23 years, who do not qualify for AFDC Medicaid, with family incomes up to and including 250 percent of the federal poverty level.

Eligibles with incomes above 150 percent of the federal poverty level are required to participate in cost sharing in the form of monthly premiums and copayments for most services. These groups are identified by the program status code (PSC) indicated below. For clarity, the program status codes related to Plan H non-cost sharing groups are also listed.