Exhibit 10.1


    

      Exhibit
        10.1

      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, the
        parties to the Contract for Furnishing Health Services by a Managed Care
        Organization ("CONTRACT"), the
        Illinois Department of Healthcare & Family Services (formerly Public
        Aid),
        201
        South Grand Avenue East, Springfield, Illinois 62763-0001 (herein referred
        to as
        "Department"), acting by and through its Director, and
        Harmony Health Plan of Illinois, Inc.,
        125
        South Wacker Drive, Suite 2600, Chicago, IL 60606 (hereinafter referred to
        as
        "Contractor"), desire to amend the CONTRACT; and

       

      WHEREAS,
        the
        Department is statutorily obligated to amend this Contract to achieve net
        liability savings in its managed care appropriation, and;

       

      WHEREAS,
        the
        Department's actuary has certified that the Contract and rates resulting
        from
        this amendment are actuarially sound;

       

      NOW
        THEREFORE,
        the
        parties agree to amend the contract as follows:

       

      1.
        Article V, Section 5.1 of the contract is amended to read as follows effective
        for dates of service August 1, 2005, and later;

       

      5.1
        Services.

       

      (a)
        Amount,
        Duration and Scope of Coverage.
        The
        Contractor shall comply with the terms of 42 C.F.R. §438.206(b) and provide or
        arrange to have provided to all Enrollees all services described in 89 111.
        Adm.
        Code, Part 140 as amended from time to time and not specifically excluded
        therein or in this Article V, Section 5.1 in accordance with the terms of
        this
        Contract. Covered Services shall be provided in the amount, duration and
        scope
        as set forth in 89 111. Adm. Code, Part 140 and this Contract, and shall
        be
        sufficient to achieve the purposes for which such Covered Services are
        furnished. This duty shall commence at the time of initial coverage as to
        each
        Enrollee. The Contractor shall, at all times, cover the appropriate level
        of
        service (i.e., triage, urgent) for all Emergency Services provided in an
        emergency room setting. The Contractor shall notify the Department in writing
        within five (5) days following a change in the Contractor's network of
        Affiliated Providers that renders the Contractor unable to provide one (1)
        or
        more Covered Service(s) in any Contracting Area. The Contractor shall not
        refer
        Enrollees to publicly supported health care entities to receive Covered
        Services, for which the Contractor receives payment from the Department,
        unless
        such entities are Affiliated with the Contractor's Plan. Such publicly supported
        health care entities include, but are not limited to, Chicago Department
        of
        Public Health and its clinics, Cook County Bureau of Health Services, and
        local
        health departments. The Contractor shall provide a mechanism for an Enrollee
        to

       

       


      
        
          Page
            l

        

        
          
          

          
          

        

        
          
          

        

      


       

      


      obtain
        a
        second opinion from a qualified Provider, whether Affiliated or non-Affiliated,
        at no cost to the Enrollee.

       

      (b)
        Enumerated
        Covered Services.
        The
        Contractor shall have a sufficient number of Affiliated Providers (including
        Tertiary Care hospital(s) and, where appropriate, advanced practice nurses)
        in
        place to provide all of the following services and benefits (which shall
        be
        specifically included as Covered Services under this Contract) to Enrollees
        at
        all times during the term of this Contract, whenever Medically Necessary,
        except
        to the extent services are identified as excluded services pursuant to
        subsection (e) of this Section 5.1:

       

      •
        Assistive/augmentative communication devices;

       

      •
        Audiology services, physical therapy, occupational therapy and speech
        therapy;

       

      •
        Behavioral health services, including subacute alcohol and substance abuse
        services and mental health services, in accordance with subsection (c)
        hereof;

       

      •
Blood,
        blood components and the administration thereof;

       

      •
        Certified hospice services;

       

      •
        Chiropractic services;

       

      •
Clinic
        services (as described in 89 111. Adm. Code, Part 140.460);

       

      •
        Diagnosis and treatment of medical conditions of the eye;

       

      •
Durable
        and nondurable medical equipment and supplies;

       

      •
        Emergency Services;

       

      •
Family
        planning services;

       

      •
Home
        health care services;

       

      •
        Inpatient hospital services (including dental hospitalization in case of
        trauma
        or when related to a medical condition and acute medical
        detoxification);

       

      •
        Inpatient psychiatric care;

       

      •
        Laboratory and x-ray services; The drawing of blood for lead screening shall
        take place within the Contractor's Affiliated facilities or elsewhere at
        the
        Contractor's expense.**

       

      


      _______________________

      *Covered
        Services may be provided by an optometrist operating within the scope of
        his
        license.

       

       


      
        
          
          

        

        
          Page
            2

          
          

        

        
          
          

        

      


       

      


      •
Medical
        procedures performed by a dentist;

       

      •
Nurse
        midwives services;

       

      •
Nursing
        facility services for the first ninety (90) days;

       

      •
        Orthotic/prosthetic devices, including prosthetic devices or reconstructive
        surgery incident to a mastectomy;

       

      •
        Outpatient hospital services (excluding outpatient behavioral health
        services);

       

      •
        Physicians' services, including psychiatric care;

       

      •
        Podiatric services;

       

      •
Routine
        care in conjunction with certain investigational cancer treatments, as provided
        in Public Act 91-0406;

       

      •
        Services required to treat a condition diagnosed as a result ofEPSDT services,
        in accordance with 89 111. Adm. Code 140.485;

       

      •
        Services to Prevent Illness and Promote Health in accordance with subsection
        (d)
        hereof;

      


      •
        Transplants covered under 89 111. Adm. Code 148.82 (using transplant providers
        certified by the Department, if the procedure is performed in the State);
        and

      


      •
        Transportation to secure Covered Services.

       

      (c)
        Behavioral
        Health Services.

                  

                  (1)
        The Contractor
        will provide the following behavioral health services, which are Covered
        Services:

       

      •
        Inpatient psychiatric or substance abuse services that are provided in general
        hospital medical units;

      


      


      _________________________________

      


      **A11
        laboratory tests for children being screened for lead must be sent for analysis
        to the Illinois Department of Public Health's laboratory.

       

      ***
        Contractors will be responsible for covering up to a maximum of ninety (90)
        days
        nursing facility care (or equivalent care provided at home because a skilled
        nursing facility is not available) annually per Enrollee. Periods in excess
        of
        ninety (90) days annually will be paid by the Department according to its
        prevailing reimbursement system.

       

       


      
        
          
          

        

        
          Page
            3

          
          

        

        
          
          

        

      


       

      


      •
        Inpatient psychiatric services provided in a hospital that is a psychiatric
        hospital or a distinct psychiatric unit, as defined in 89 111. Adm. Code
        148.40(a)(l);

       

      •
        Inpatient
        acute
        alcoholism and substance abuse treatment (detoxification);

       

      •
        Hospital-based organized clinic services referred to as outpatient treatment
        psychiatric services for Type A and Type B Psychiatric Clinic Services, as
        defined in 89 111. Adm. Code 148.140(b)(l)(E);

       

      •
        Behavioral health services provided
        by
        Physicians, including psychiatrists;

       

      and

       

      •
        Laboratory services provided on an outpatient basis for behavioral health,
        even
        if ordered by a behavioral health provider in connection with the provision
        of
        treatment that is excluded from Covered Services.

       

      (2)
        If an
        Enrollee presents himself to the Contractor for behavioral health services,
        or
        is referred through a third party, the Contractor will complete a behavioral
        health assessment.

       

      
        	•	
                If
                  the assessment indicates that all services needed are within the
                  scope of
                  Covered Services, the Contractor will arrange for the provision
                  of all
                  such Covered Services.

              


      

       

      
        	
              	•	
                If
                  the assessment indicates that outpatient services are needed beyond
                  the
                  scope of Covered Services, the Contractor will explain to the Enrollee
                  the
                  services needed and the importance of obtaining them and provide
                  the
                  Enrollee with a list of Community Behavioral Health Providers (CBHP).
                  The
                  Contractor will assist the Enrollee in contacting a CBHP chosen
                  by the
                  Enrollee, unless the Enrollee
                  objects.

              


      

       

      
        	
              	•	
                If
                  a Enrollee obtains needed comprehensive services through a CBHP,
                  the
                  Contractor will be responsible for payment for laboratory services
                  in
                  connection with the comprehensive services provided by the CBHP.
                  The
                  Contractor shall not be liable for other Covered Services provided
                  by the
                  CBHP. The Contractor may require that laboratory services are provided
                  by
                  Providers that are Affiliated with
                  Contractor.

              


      

       

      (d)
        Services
        to Prevent Illness and Promote Health.
        The
        Contractor shall make documented efforts to provide initial health screenings
        and preventive care to all Enrollees. The Contractor shall provide, or arrange
        to provide, the following Covered Services to all Enrollees, as appropriate,
        to
        prevent illness and promote health:

       

      


       

      (1)
        EPSDT
        services in accordance with 89 111. Adm. Code 140.485 and described in this
        Article V, Section 5.12(a);

       

      


       

       


      
        
          
          

        

        
          Page
            4

          
          

        

        
          
          

        

      


       

      


      (2)
        Preventive Medicine Schedule which shall address preventive health care issues
        for Enrollees twenty-one (21) years of age or older (Article V, Section
        5.12(b));

       

      (3)
        Maternity care for pregnant Enrollees (Article V, Section 5.12(c));

       

      and

       

      (4)
        Family planning services and supplies, including physical examination and
        counseling provided during the visit, annual physical examination for family
        planning purposes, pregnancy testing, voluntary sterilization, insertion
        or
        injection of contraceptive drugs or devices, and related laboratory and
        diagnostic testing (except to the extent an Enrollee has chosen to obtain
        such
        services and supplies from a non-Affiliated Provider, in which case the
        Department shall be responsible for providing payment for such
        services).

       

      (e)
        Exclusions
        from Covered Services.
        In
        addition to those services and benefits excluded from Covered Services by
        89
        111. Adm. Code, Part 140, as amended from time to time, the following services
        and benefits shall NOT be included as Covered Services:

       

      (1)
        Dental services;

       

      (2)
        Mental health clinic services as provided through a community behavioral
        health
        provider as identified in 89 111. Adm. Code 140.452 and 140.454 and further
        defined in 59 111. Adm. Code, Part 132 "Medicaid Community Mental Health
        Services Program.";

       

      (3)
        Subacute alcoholism and substance abuse treatment services as provided through
        a
        community behavioral health provider as identified in 89 111. Adm. Code
        148.340(a) and further defined in 77 111. Adm. Code 2090;

       

      (4)
        Routine examinations to determine visual acuity and the refractive state
        of the
        eye, eyeglasses, other devices to correct vision, and any associated supplies
        and equipment. The Contractor shall refer Enrollees needing such services
        to
        Providers participating in the Medical Assistance Program able to provide
        such
        services, or to a central referral entity that maintains a list of such
        Providers;

       

      (5)
        Nursing facility services, or equivalent care provided at home because a
        skilled
        nursing facility is unavailable, beginning on the ninety-first (91st) day
        of
        service in a calendar year;

       

      (6)
        Services provided in an Intermediate Care Facility for the Mentally
        Retarded/Developmentally Disabled and services provided in a nursing facility
        to
        mentally retarded or developmentally disabled Participants;

       

      (7)
        Early
        intervention services, including case management, provided pursuant to the
        Early
        Intervention Services System Act (325 ILCS 20 et seq.);

       

      (8)
        Services provided through school-based clinics as such clinics are defined
        by
        the Department;

       

      


       

       


      
        
          
          

        

        
          
          

          Page
            5

        

        
          
          

        

      


       

      


      (9)
        Services provided through local education agencies that are enrolled with
        the
        Department under an approved individual education plan (IEP);

       

      (10)
        Services provided under Section 1915(c) home and community-based
        waivers;

       

      (11)
        Services funded through the Juvenile Rehabilitation Services Medicaid Matching
        Fund;

       

      (12)
        Services that are experimental and/or investigational in nature;

       

      (13)
        Services provided by a non-Affiliated Provider and not authorized by the
        Contractor, unless this Contract specifically requires that such services
        be
        covered;

       

      (14)
        Services that are provided without first obtaining a required referral or
        prior
        authorization as set forth in the Enrollee handbook;

       

      (15)
        Medical and/or surgical services provided solely for cosmetic
        purposes;

       

      (16)
        Diagnostic and/or therapeutic procedures related to infertility/sterility;
        and

       

      (17)
        Pharmacy services.

       

      (f)
        Limitations
        on Covered Services.
        The
        following services and benefits shall be limited as Covered
        Services:

       

      (1)
        Termination of pregnancy shall be provided only as allowed by applicable
        State
        and federal law (42 C.F.R. Part 441, Subpart E). In any such case, the
        requirements of such laws must be fully complied with and DPA Form 2390 must
        be
        completed and filed in the Enrollee's medical record. Termination of pregnancy
        shall not be provided to KidCare Enrollees.

       

      (2)
        Sterilization services may be provided only as allowed by State and federal
        law
        (see 42 C.F.R. Part 441, Subpart F). In any such case, the requirements of
        such
        laws must be fully complied with and a DPA Form 2189 must be completed and
        filed
        in the Enrollee's medical record.

       

      (3)
        If a
        hysterectomy is provided, a DPA Form 1977 must be completed and filed in
        the
        Enrollee's medical record.

       

      (g)
        Right
        of Conscience.
        The
        parties acknowledge that pursuant to 745 ILCS 70/1 et seq.,
        a
        Contractor may choose to exercise a right of conscience by not rendering
        certain
        Covered Services. Should the Contractor choose to
        exercise this right, the Contractor must promptly notify the Department of
        its
        intent to exercise its right of conscience in writing. Such notification
        shall
        contain the services that the Contractor is unable to render pursuant to
        the
        exercise of the right of conscience. The parties agree that at that time
        the
        Department shall adjust the Capitation payment to the Contractor and amend
        the
        contract accordingly.

       

       


      
        
          
          

        

        
          Page
            6

          
          

        

        
          
          

        

      


       

      


      Should
        the Contractor choose to exercise this right, the Contractor must notify
        Potential Enrollees, Prospective Enrollees and Enrollees that it has chosen
        to
        not render certain Covered Services, as follows:

       

      (1)
        To
        Potential Enrollees, prior to Enrollment;

       

      (2)
        To
        Prospective Enrollees, during Enrollment; and

       

      (3)
        To
        Enrollees, within ninety (90) days after adopting a policy with respect to
        any
        particular service that previously was a Covered Service.

       

      (h)
        Emergency
        Services.

       

      (1)
        The
        Contractor shall cover Emergency Services for all Enrollees whether the
        Emergency Services are provided by an Affiliated or non-Affiliated
        Provider.

       

      (2)
        The
        Contractor shall not impose any requirements for prior approval of Emergency
        Services. If an Enrollee calls the Contractor to request Emergency Services,
        such call shall receive an immediate response.

       

      (3)
        The
        Contractor shall cover Emergency Services for Enrollees who are temporarily
        away
        from their residence and outside the Contracting Area for all Emergency Services
        to which they would be entitled within the Contracting Area.

       

      (4)
        The
        Contractor shall have no obligation to cover medical services provided on
        an
        emergency basis that are not Covered Services under this Contract.

       

      (5)
        Elective care or care required as a result of circumstances that could
        reasonably have been foreseen prior to the Enrollee's departure from the
        Contracting Area are not covered. Unexpected hospitalization due to
        complications of pregnancy shall be covered. Routine delivery at term outside
        the Contracting Area, however, shall not be covered if the Enrollee is outside
        the Contracting Area against medical advice unless the Enrollee is outside
        of
        the Contracting Area due to circumstances beyond her control. The Contractor
        must educate the Enrollee of the medical and financial implications of leaving
        the Contracting Area and the importance of staying near the treating Provider
        throughout the last month of pregnancy.

       

      (6)
        The
        Contractor shall provide ongoing education to Enrollees regarding the
        appropriate use of Emergency Services.

       

      (7)
        The
        Contractor shall not condition coverage for Emergency Services on the treating
        Provider notifying the Contractor of the Enrollee's screening and treatment
        within ten (10) calendar days of presentation for Emergency
        Services.

       

      (8)
        The
        determination of whether or not an Enrollee is sufficiently Stabilized for
        discharge or transfer to another facility shall be binding on the
        Contractor.

       

      (i)
        Post-Stabilization
        Services.
        The
        Contractor shall cover Post-Stabilization Services provided by an Affiliated
        or
        non-Affiliated Provider in any the following situations: (a)

       

      


       

       


      
        
          
          

        

        
          Page
            7

          
          

        

        
          
          

        

      


       

      


      the
        Contractor authorized such services; (b) such services were administered
        to
        maintain the Enrollee's stabilized condition within one (1) hour of a request
        to
        the Contractor for authorization of further Post-Stabilization Services;
        or (c)
        the Contractor does not respond to a request to authorize further
        Post-Stabilization Services within one (1) hour, the Contractor could not
        be
        contacted, or the Contractor and the treating Provider cannot reach an agreement
        concerning the Enrollee's care and an Affiliated Provider is unavailable
        for a
        consultation, in which case the treating Provider must be permitted to continue
        the care of the Enrollee until an Affiliated Provider is reached and either
        concurs with the treating Provider's plan of care or assumes responsibility
        for
        the Enrollee's care.

       

      (j)
        Additional
        Services or Benefits.
        The
        Contractor shall obtain prior approval from the Department before offering
        any
        additional service or benefit not required under this Contract to all Enrollees.
        The Contractor shall notify Enrollees before discontinuing an additional
        service
        or benefit. The notice to Enrollees must be approved in advance by the
        Department. The Contractor shall continue any ongoing course of treatment
        for an
        Enrollee then receiving such service or benefit.

       

      (k)
        Telephone
        Access.
        The
        Contractor shall establish a toll-free twenty-four (24) hour telephone number
        to
        confirm eligibility for benefits and seek prior approval for treatment where
        required under the Plan, and shall assure twenty-four (24) hour access, via
        telephone(s), to medical professionals, either to the Plan directly or to
        the
        Primary Care Providers, for consultation to obtain medical care. The Contractor
        must also make a toll-free number available, at a minimum during the business
        hours of 9:00 a.m. until 5:00 p.m. on regular business days. This number
        also
        will be used to confirm eligibility for benefits, for approval for non-emergency
        services and for Enrollees to call to request Site, Primary Care Provider,
        or
        Women's Health Care Provider changes, to make complaints or grievances, to
        request disenrollment and to ask questions. The Contractor may use one toll-free
        number for these purposes or may establish two separate numbers.

       

      2.
        Any
        references in the contract to pharmacy services inconsistent with the changes
        in
        Article V, Section 5.1 for dates of service August 1, 2005 or later shall
        be
        read in a manner consistent with the changes in Article V, Section
        5.1.

       

      3.
        The
        following provision is added to the contract at Article VII, Section
        7.12:

       

      7.12
        Medical
        Loss Ratio Guarantee

       

      (a)
        For
        each calendar quarter that this contract is in effect, effective with the
        quarter beginning April 1, 2005, if the Contractor's Medical Loss Ratio (MLR)
        is
        less than 82%, the Department will recover by deduction from future payments
        a
        percentage of the quarter's premium revenue equal to the difference between
        the
        reported MLR and 82%.

       

      (b)
        Medical Loss Ratio shall be calculated by dividing total hospital and medical
        expenses incurred in Illinois by premium revenue paid by the Department.
        Premium
        revenue for a quarter shall be the premium revenue accrued, including Hospital
        Delivery Case Rate Payments. Expenses reported as Incurred But Not Reported
        (IBNR) shall be subject to review by the Department for actuarial soundness.
        All
        elements of reports used to calculate MLR are subject to audit by the
        Department. Audits may be ordered by the Department within

       

      


       

      


       

       


      
        
          
          

        

        
          Page
            8

          
          

        

        
          
          

        

      


       

      


      30
        days
        of Departmental receipt of each quarterly report, and audits shall encompass
        the
        total subject matter of that report.

       

      (c)
        Hospital and medical expenses are the incurred costs of providing direct
        care to
        Enrollees for Covered Services. Outreach and general education are not included
        in medical expenses.

       

      (d)
        At
        the end of the four quarters ending March 31, 2006, the Department will review
        the Contractor's MLR for the full four quarters and recover or reconcile
        previous recoveries so that the Department has recovered the percentage of
        the
        total premium revenue for the four quarters equal to the difference between
        the
        cumulative MLR below 82% and 82%. Reconciliation shall consist of payment
        by the
        Contractor of any difference below the annualized 82% MLR not previously
        deducted, or repayment to the Contractor of deductions over the annualized
        82%
        MLR previously made by the Department. A similar reconciliation will be
        performed at the end of each four quarters or the termination of any contractual
        relationship between the parties. Notwithstanding the provisions of section
        7.12(b), the Department may order an audit of the reporting for the full
        four
        quarters within 45 days of Departmental receipt of a cumulative report of
        the
        four quarters.

       

      (e)
        The
        Contractor shall report all information necessary to effectuate this section
        in
        a format and on a schedule consistent with NAIC guidelines. The Department
        may
        request additional supporting information necessary to effectuate this section,
        and the Contractor shall report this information to the Department in a timely
        manner.

       

      (f)
        For
        purposes of calculating the Contractor's MLR, for the quarter beginning April
        1,
        2005, and for the month of July 2005, premium revenue will be adjusted to
        remove
        premium revenue for pharmacy services in excess of Contractor's costs for
        pharmacy services.

       

      4.
        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.

       

      All
        other
        terms and conditions of the CONTRACT shall remain in full force and
        effect.

       

       

      
        
          
          

        

        
          Page
            9

          
          

        

        
          
          

        

      

       

      


      IN
        WITNESS WHEREOF,
        the
        parties have hereunto caused this agreement to amend the CONTRACT to be executed
        by their duly authorized representatives, effective August 1, 2005.

      
 

      
        
          	
                      DEPARTMENT
                    OF
                    HEALTHCARE & FAMILY SERVICES

                   

                      By:
                    /s/
                    Barry S. Maram

                  Barry
                    S. Maram

                   

                       Title:
Director

                       Date:7/29/05

                	
                  HARMONY
                    HEALTH PLAN OF ILLINOIS, INC.

                  By:
                    /s/ Todd S. Farha

                   

                   

                  Printed
                    Name: Todd
                    S. Farha

                  Title:
                    President
                    and CEO

                  Date:
                    7/27/05

                  Fein:
                    36-4050495

                


        



       

       

       

       

      


      
        
          
          

        

        
          Page
            10

          
          

        

        
          
          

        

      

      SECOND
        AMENDED ATTACHMENT I RATE SHEETS

       

      (a)
        Contractor Name: Harmony Health Plan of Illinois, me.

       

      Address:
        125 South Wacker Drive, Suite 2600 

       

      Chicago,
        IL 60606

       

      (b)
        Contracting Area(s) Covered by the Contractor and Enrollment Limit:

       

      
        	
                 

                Contracting
                  Area

              	
                 

                Enrollment
                  Limit

              
	
                 

                The
                  following counties in Region III: 

                 

                Franklin
                  (effective 03/15/04 through 8/31/05) Jackson (effective 09/01/03
                  through
                  8/31/05) Madison Perry (effective 09/01/03) 

                 

                Randolph
                  (effective 09/01/03) 

                 

                St.
                  Clair Washington (effective 09/01/03) Williamson (effective 09/01/03
                  through 8/31/05)

              	
                 

                50,000

              
	
                 

                Region
                  IV

              	
                 

                100,000

              


      

       

      (c)
        Total
        Enrollment Limit for all Contracting Areas: 150,000

       

      (d)
        Threshold Review Levels: Counties listed above in Region III:     40,000 

                       Region
        IV                  80,000

      (e)
        Standard Capitation Rates for Enrollees, effective
        August 1,2003
        through
        July 31,2005:

       

      
        	
                 

                Age/Gender
                  Mo = month Yr == year

              	
                 

                Region
                  I (N.W. Illinois) PMPM

              	
                 

                Region
                  II (Central Illinois) PMPM

              	
                 

                Region
                  III (Southern Illinois) PMPM

              	
                 

                Region
                  IV (Cook County) PMPM

              	
                 

                Region
                  V (Collar Counties) PMPM

              
	
                 

                0-3Mo

              	
                 

                $1,152.25

              	
                 

                $1,178.77

              	
                 

                $1,242.71

              	
                 

                $1,244.64

              	
                 

                $854.58

              
	
                 

                4Mo-lYr

              	
                 

                127.81

              	
                 

                117.63

              	
                 

                165.94

              	
                 

                125.04

              	
                 

                108.35

              
	
                 

                2Yr-5Yr

              	
                 

                63.77

              	
                 

                67.81

              	
                 

                71.74

              	
                 

                58.67

              	
                 

                56.28

              
	
                 

                6Yr-13Yr

              	
                 

                72.08

              	
                 

                79.78

              	
                 

                75.18

              	
                 

                58.18

              	
                 

                57.47

              
	
                 

                14Yr-20Yr,
                  Male

              	
                 

                115.93

              	
                 

                135.96

              	
                 

                131.18

              	
                 

                90.67

              	
                 

                142.60

              
	
                 

                14Yr-20Y,
                  Female

              	
                 

                148.51

              	
                 

                157.40

              	
                 

                155.15

              	
                 

                112.48

              	
                 

                119.82

              
	
                 

                21Yr-44Yr,
                  Male

              	
                 

                161.79

              	
                 

                216.53

              	
                 

                201.90

              	
                 

                164.23

              	
                 

                159.43

              
	
                 

                21Yr-44Yr,
                  Female

              	
                 

                217.61

              	
                 

                228.14

              	
                 

                237.13

              	
                 

                185.81

              	
                 

                184.20

              
	
                 

                45Yr+
                  Male and Female

              	
                 

                437.86

              	
                 

                486.40

              	
                 

                476.29

              	
                 

                359.61

              	
                 

                409.17

              


      

       

       


      
        
          
          

        

        
          Att.
            I -1

          
          

        

        
          
          

        

      


       

      Standard
        Capitation Rates for Enrollees, effective
        August 1, 2005
        through
        July 31, 2006:

      
        	
                 

                Age/Gender
                  Mo = month Yr = year

              	
                 

                Region
                  I

                 

                (N.W.
                  Illinois) PMPM

              	
                 

                Region
                  II (Central Illinois) PMPM

              	
                 

                Region
                  III (Southern Illinois) PMPM

              	
                 

                Region
                  IV (Cook County) PMPM

              	
                 

                Region
                  V (Collar Counties) PMPM

              
	
                 

                0-3Mo

              	
                 

                $1,342.61

              	
                 

                $1,178.83

              	
                 

                $1,271.32

              	
                 

                $1,369.28

              	
                 

                $948.46

              
	
                 

                4Mo-lYr

              	
                 

                121.62

              	
                 

                109.83

              	
                 

                154.41

              	
                 

                117.41

              	
                 

                99.27

              
	
                 

                2Yr-5Yr

              	
                 

                53.51

              	
                 

                57.02

              	
                 

                59.41

              	
                 

                51.49

              	
                 

                49.60

              
	
                 

                6Yr-13Yr

              	
                 

                49.37

              	
                 

                51.29

              	
                 

                52.22

              	
                 

                45.53

              	
                 

                42.00

              
	
                 

                14Yr-20Yr,
                  Male

              	
                 

                85.90

              	
                 

                92.02

              	
                 

                85.37

              	
                 

                70.16

              	
                 

                100.73

              
	
                 

                14Yr-20Y,
                  Female

              	
                 

                127.53

              	
                 

                128.58

              	
                 

                123.97

              	
                 

                94.84

              	
                 

                98.76

              
	
                 

                21Yr-44Yr,Male

              	
                 

                113.28

              	
                 

                161.06

              	
                 

                139.13

              	
                 

                121.91

              	
                 

                110.33

              
	
                 

                21Yr-44Yr,
                  Female

              	
                 

                164.91

              	
                 

                167,03

              	
                 

                168.42

              	
                 

                148.97

              	
                 

                141.81

              
	
                 

                45Yr+
                  Male and Female

              	
                 

                277.48

              	
                 

                310.00

              	
                 

                275.75

              	
                 

                258.08

              	
                 

                273.13

              


      

       

      (f) Hospital
        Delivery Case Rate, effective August 1, 2003 through July 31, 2005:

       

      
        	
                 

                Hospital
                  Delivery Case Rate

                 

                (per
                  delivery)

              	
                 

                $3,196.12

              	
                 

                $3,104.66

              	
                 

                $3,281.22

              	
                 

                $3,748.33

              	
                 

                $3,276.03

              


      

       

      Hospital
        Delivery Case Rate, effective
        August 1, 2005
        through
        July 31,2006:

       

      
        	
                 

                Hospital
                  Delivery Case Rate (per delivery)

              	
                 

                $3,008.88

              	
                 

                $2,900.77

              	
                 

                $3,100.59

              	
                 

                $3,431.08

              	
                 

                $3,113.07

              


      

       

      Alt.
        I -
        2