exv10w3






Exhibit 10.3




2008-000065G




PHYSICAL HEALTH INSURANCE CONTRACT



AGREEMENT BETWEEN


Puerto Rico Health Insurance Administration (PRHIA) a public instrumentality of the
Commonwealth of Puerto Rico organized pursuant to Act 72, of September 7, 1993, as amended,
hereinafter referred to as the “ADMINISTRATION”, and represented by its Executive Director, Domingo
Nevárez Ramírez, MHSA;




And



TRIPLE-S SALUD, INC., a private corporation duly organized and authorized to do business under
the laws of the Commonwealth of Puerto Rico, with Employer Social Security Number ###-##-####,
hereinafter referred to as “INSURER”, and represented by its Chief Executive Officer, Ms. Socorro
Rivas;




Contractor Name




For the Provision of Health Insurance

coverage to eligible population under the

Government Health Insurance Plan



 









 





WITNESSETH



In consideration of the mutual covenants and agreements hereinafter set forth, the parties,
their personal representative and successors, agree as follows:



WHEREAS: The parties entered into Contract number 08-065 (the Contract) to provide health insurance
coverage for the North and Southwest Areas medically indigent population; enrolled in the
Government Health Insurance Plan (GHIP) for the period through November 1, 2006 until June 30,
2008.



WHEREAS: The Contract was extended through the Amendment Number 08-065-F from July 1, 2008 until
October 31, 2009, in consideration of the period of time needed by the ADMINISTRATION Board of
Directors to decided who are the proponents selected to begin negotiations with the
ADMINISTRATION.



WHEREAS: The Board of Directors of the ADMINISTRATION in a Extraordinary Meeting celebrated on
October 2, 2009, decided not to award contracts to any of the proponents who submitted its proposal
to the ADMINISTRATION for the physical, mental and oral health coverage under the Governmental
Health Insurance Plan. The Board recommended that the contracts be extended until June 30, 2010.
In a Meeting of the Board of Directors celebrated on October 30, 2009, the Board directed ASES to
extend the contract for a two month period (from November 1, 2009 to December 31, 2009) to give the
ADMINISTRATION the necessary time to negotiate the contract extension contemplated in the October
2, 2009 Extraordinary Meeting. In consideration of the decision of the Board of Director the
parties agree to extend the Contract until December 31, 2009.



HENCEFORTH: The appearing Parties agree to extend the Contract #08-065 and amend the Article VIII,
Article XXIX, Appendix C and incorporate a new Appendix D Guidelines for the Development of Program
Integrity Plan. The Amendment read as follows:



Article I: Add the following language at the end of Article VIII, Section 22:







 









 







For the period of the contract extension, effective from July 1, 2009 through December 31, 2009,
the ADMINISTRATION assures that it will provide an adequate stop-loss insurance set at seven
thousand five hundred dollars ($7,500.00).



Article II: To amend provision 1 in Article XXIX “Effective Date and Term” to read as follows:





	 	1.	 	This contract shall be in effect from July 1, 2008 until December 31, 2009.
	 
	 	2.	 	......
	 
	 	3.	 	......




Article III: To amend Appendix C; to incorporate premium rates for this contract period.




Article IV: To incorporate a new Appendix D, “Guidelines for the Development of Program Integrity




Plan”.



All other terms and conditions of the contract number 08-065; and its amendments 08-065A through
08-065F remain unchanged. In witness whereof, the parties have duly executed this Amendment on
this 15  day of December, 2009 and affixes below their respective signature.




	 	 	 
	/s/  Domingo Nevárez Ramírez 

Domingo Nevárez Ramírez, MHSA

	 	 
	Executive Director
	 	 
	Puerto Rico Health Insurance Administration
	 	 
	 
	 	 
	 /s/ Socorro Rivas 

SOCORRO RIVAS

	 	 
	Chief Executive Officer
	 	 
	TRIPLE-S SALUD INC.
	 	 
	 
	 	 
	/s/ Luis A. Marini 

LUIS A. MARINI, DMD

	 	 
	Chief Executive Officer
	 	 




Cifra
5000-100



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Appendix C




TRIPLE-S SALUD, INC./ TRIPLE C, INC.



The monthly premiums for all beneficiaries, including all those who are sixty-five (65) years and
older who are Medicare beneficiaries Part A or Part A and B those who are sixty-five years and
older who are not Medicare recipients is establish below on a per member per month (pmpm) rate; for
the period of July 1st, 2008 to December 31, 2009.




Monthly Premiums Rates




	 	 	 	 	 	 	 	 	 	 	 	 	 
	SSS	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Fixed Administrative	 	 
	Region or Area	 	Premiums Rates	 	Cost	 	Profit
	North

	 	$	87.99	 	 	$	6.30	 	 	$	2.20	 
	Southwest

	 	$	87.71	 	 	$	6.30	 	 	$	2.19	 





The INSURER will be paid a fixed administrative cost fee and profit included in the total
premium rate paid by the Administration as detailed above. Further, the INSURER’s aggregated net
earnings (considering all INSURER’s Health Areas/Regions contracted with the ADMINISTRATION) in
excess of 2.5 of the total aggregated earned premium in this contract year period will be shared
with the ADMINISTRATION. The ADMINISTRATION share apportionment of the earnings shall be 75% and
the INSURER share shall be 25%.


















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APPENDIX D




Guidelines for the

Development of

Program Integrity

Plan




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