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STATE OF ILLINOIS
DEPARTMENT OF PUBLIC AID
 AMENDMENT NO. 3 TO THE
CONTRACT FOR FURNISHING HEALTH SERVICES
 BY A
MANAGED CARE ORGANIZATION
2004-24-001-KA3
 Whereas, Illinois Department of Healthcare & Family Services (formerly Public Aid), AMERIGROUP Illinois, Inc.,
 WHEREAS,
 WHEREAS,
 NOW THEREFORE,
 1.
    
    First Amended Attachment I shall be deleted and replaced by the attached Second Amended
Attachment I. Each reference to Attachment I or First Amended Attachment I in the Contract
shall be replaced with a reference to Second Amended Attachment I.
  IN WITNESS WHEREOF,
 DEPARTMENT OF HEALTHCARE &
FAMILY SERVICES
    
    
    
    AMERIGROUP ILLINOIS, INC.By:
    
    
    
    
    
    By:
    
    /s/ Jared RosenthalBarry S. MaramPrinted Name:
    
    JARED ROSENTHALTitle:
    
    Director
    
    
    
    Title:
    
    CEODate:
    
    
    
    
    
    Date:
    
    12/28/05Fein:
    
    54-1761812
 
 Page 1 of 1




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SECOND AMENDED ATTACHMENT I
 RATE SHEETS
 (a)
    
    Contractor Name:
    
    AMERIGROUP Illinois, Inc.Address:
    
    211 West Wacker Drive, Suite 1350Chicago, IL 60606(b)
    
    Contracting Area(s) Covered by the Contractor and Enrollment Limit:
 Contracting Area
    
    Enrollment LimitRegion IV
    
    100,000
 (c)
    
    Total Enrollment Limit for all Contracting Areas: 100,000(d)
    
    Threshold Review Levels: 80,000(e)
    
    Standard Capitation Rates for Enrollees, effective August 1, 2003through July 31, 2005:
 Region I
    
    Region II
    
    Region III
    
    Region IV
    
    Region VAge/Gender
    
    (N.W.
    
    (Central
    
    (Southern
    
    (Cook
    
    (CollarMo = month
    
    Illinois)
    
    Illinois)
    
    Illinois)
    
    County)
    
    Counties)Yr = year
    
    PMPM
    
    PMPM
    
    PMPM
    
    PMPM
    
    PMPM0-3Mo
    
    $
    1,152.25
    
    
    $
    1,178.77
    
    
    $
    1,242.71
    
    
    $
    1,244.64
    
    
    $
    854.584Mo-1Yr
    
    
    127.81
    
    
    
    117.63
    
    
    
    165.94
    
    
    
    125.04
    
    
    
    108.352Yr-5Yr
    
    
    63.77
    
    
    
    67.81
    
    
    
    71.74
    
    
    
    58.67
    
    
    
    56.286Yr-13Yr
    
    
    72.08
    
    
    
    79.78
    
    
    
    75.18
    
    
    
    58.18
    
    
    
    57.4714Yr-20Yr, Male
    
    
    115.93
    
    
    
    135.96
    
    
    
    131.18
    
    
    
    90.67
    
    
    
    142.6014Yr-20Y, Female
    
    
    148.51
    
    
    
    157.40
    
    
    
    155.15
    
    
    
    112.48
    
    
    
    119.8221Yr-44Yr, Male
    
    
    161.79
    
    
    
    216.53
    
    
    
    201.90
    
    
    
    164.23
    
    
    
    159.4321Yr-44Yr, Female
    
    
    217.61
    
    
    
    228.14
    
    
    
    237.13
    
    
    
    185.81
    
    
    
    184.2045Yr+ Male and Female
    
    
    437.86
    
    
    
    486.40
    
    
    
    476.29
    
    
    
    359.61
    
    
    
    409.17
 Att. I - 1




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August 1, 2005 December 31, 2005:
 Region I
    
    Region II
    
    Region III
    
    Region IV
    
    Region VAge/Gender
    
    (N.W.
    
    (Central
    
    (Southern
    
    (Cook
    
    (CollarMo = month
    
    Illinois)
    
    Illinois)
    
    Illinois)
    
    County)
    
    Counties)Yr = year
    
    PMPM
    
    PMPM
    
    PMPM
    
    PMPM
    
    PMPM0-3Mo
    
    $
    1,342.61
    
    
    $
    1,178.83
    
    
    $
    1,271.32
    
    
    $
    1,369.28
    
    
    $
    948.464Mo-1Yr
    
    
    121.62
    
    
    
    109.83
    
    
    
    154.41
    
    
    
    117.41
    
    
    
    99.272Yr-5Yr
    
    
    53.51
    
    
    
    57.02
    
    
    
    59.41
    
    
    
    51.49
    
    
    
    49.606Yr-13Yr
    
    
    49.37
    
    
    
    51.29
    
    
    
    52.22
    
    
    
    45.53
    
    
    
    42.0014Yr-20Yr, Male
    
    
    85.90
    
    
    
    92.02
    
    
    
    85.37
    
    
    
    70.16
    
    
    
    100.7314Yr-20Y, Female
    
    
    127.53
    
    
    
    128.58
    
    
    
    123.97
    
    
    
    94.84
    
    
    
    98.7621Yr-44Yr, Male
    
    
    113.28
    
    
    
    161.06
    
    
    
    139.13
    
    
    
    121.91
    
    
    
    110.3321 Yr-44Yr, Female
    
    
    164.91
    
    
    
    167.03
    
    
    
    168.42
    
    
    
    148.97
    
    
    
    141.8145Yr+ Male and
Female
    
    
    277.48
    
    
    
    310.00
    
    
    
    275.75
    
    
    
    258.08
    
    
    
    273.13
 January 1, 2006 July 31, 2006:
 Region I
    
    Region II
    
    Region III
    
    Region IV
    
    Region VAge/Gender
    
    (N.W.
    
    (Central
    
    (Southern
    
    (Cook
    
    (CollarMo = month
    
    Illinois)
    
    Illinois)
    
    Illinois)
    
    County)
    
    Counties)Yr = year
    
    PMPM
    
    PMPM
    
    PMPM
    
    PMPM
    
    PMPM0-3Mo
    
    $
    1,361.60
    
    
    $
    1,193.95
    
    
    $
    1,283.86
    
    
    $
    1,379.13
    
    
    $
    967.154Mo-1Yr
    
    
    131.76
    
    
    
    117.74
    
    
    
    161.46
    
    
    
    124.11
    
    
    
    109.202Yr-5Yr
    
    
    57.39
    
    
    
    60.36
    
    
    
    62.06
    
    
    
    54.89
    
    
    
    53.376Yr-13Yr
    
    
    51.57
    
    
    
    53.28
    
    
    
    53.69
    
    
    
    47.37
    
    
    
    43.9614Yr-20Yr, Male
    
    
    87.51
    
    
    
    93.46
    
    
    
    86.43
    
    
    
    71.41
    
    
    
    102.0014Yr-20Y, Female
    
    
    129.71
    
    
    
    130.56
    
    
    
    125.42
    
    
    
    96.23
    
    
    
    100.4621Yr-44Yr, Male
    
    
    113.43
    
    
    
    161.32
    
    
    
    139.61
    
    
    
    122.11
    
    
    
    110.3921 Yr-44Yr, Female
    
    
    165.30
    
    
    
    167.59
    
    
    
    169.54
    
    
    
    149.54
    
    
    
    142.1145Yr+ Male and Female
    
    
    277.85
    
    
    
    310.54
    
    
    
    276.86
    
    
    
    258.60
    
    
    
    273.38
 (f)
    
    Hospital Delivery Case Rate, effective August 1, 2003through July 31, 2005:
 Hospital Delivery CaseRate
    
    $
    3,196.12
    
    
    $
    3,104.66
    
    
    $
    3,281.22
    
    
    $
    3,748.33
    
    
    $
    3,276.03(per delivery)
 August 1, 2005 July 31, 2006:
 Hospital Delivery CaseRate
    
    $
    3,008.88
    
    
    $
    2,900.77
    
    
    $
    3,100.59
    
    
    $
    3,431.08
    
    
    $
    3,113.07(per delivery)
 Att. I - 2