exv10w3






Exhibit 10.3




2008-000065F




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 Area 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-E from July 1, 2008 until
June 30, 2009.




WHEREAS: The ADMINISTRATION is in the process of preparing, drafting and issuing a Request for
Proposal, to award contracts for the physical, dental and mental health coverage for the GHIP. In
consideration of the period of time needed to prepare the RFP, the parties agree to extend the
Contract until October 31, 2009.




HENCEFORTH: The appearing Parties agree to extend the Contract #08-065 and amend the Article VIII,
Article XXIX and Appendix C, 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 to October 31, 2009, Insurer
assures that it will provide and adequate stop-loss insurance set at five thousand dollars
($5,000.00).




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 October 31, 2009.
	 
	 	2.	 	......
	 
	 	3.	 	.......





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




 









 








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




                                                            

Domingo Nevárez Ramírez, MHSA

Executive Director

Puerto Rico Health Insurance Administration




                                                            

SOCORRO RIVAS

Chief Executive Officer

TRIPLE-S SALUD INC.




                                                            

LUIS A. MARINI, DMD

Chief Executive Officer




Cifra 5000-212




 









 





Appendix C




TRIPLE S / 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 October 31, 2009.




Monthly Premiums Rates




	 	 	 	 	 	 	 	 	 	 	 	 	 
	SSS	 	 	 	 	 	Fixed Administrative	 	 
	Region or Area	 	Premiums	 	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%.