Document:

Exhibit 10.163

 

HMO
IPA/Medical Group Shared Savings Provider Agreement, effective February 1,
2003, between Northwest Orange County Medical Group

 

***
Confidential Treatment requested

 

 

BLUE SHIELD

 

HMO IPA/MEDICAL GROUP

 

SHARED SAVINGS PROVIDER AGREEMENT

 

1

 

TABLE OF CONTENTS

 

	
  I.

  	
  DEFINITIONS

  
	
   

  	
  1.1

  	
  Agreement Year

  
	
   

  	
  1.2

  	
  Authorization

  
	
   

  	
  1.3

  	
  Benefit Program

  
	
   

  	
  1.4

  	
  Blue
  Shield Providers

  
	
   

  	
  1.5

  	
  Capitated Professional
  Services

  
	
   

  	
  1.6

  	
  Capitation

  
	
   

  	
  1.7

  	
  Copayments

  
	
   

  	
  1.8

  	
  Covered Services

  
	
   

  	
  1.9

  	
  Emergency
  Services

  
	
   

  	
  1.10

  	
  Evidence
  of Coverage

  
	
   

  	
  1.11

  	
  Group Provider

  
	
   

  	
  1.12

  	
  Group Service Area

  
	
   

  	
  1.13

  	
  Health
  Services Contract

  
	
   

  	
  1.14

  	
  Medically
  Necessary

  
	
   

  	
  1.15

  	
  Member

  
	
   

  	
  1.16

  	
  Primary Care Physician

  
	
   

  	
  1.17

  	
  Provider Manual

  
	
   

  	
  1.18

  	
  Shared
  Risk Services

  
	
   

  	
  1.19

  	
  Urgent
  Care Services

  
	
   

  	
   

  	
   

  
	
  II.

  	
  OBLIGATIONS
  OF GROUP

  
	
   

  	
  2.1

  	
  Capitated Professional Services

  
	
   

  	
  2.2

  	
  Referrals For Other Covered Services

  
	
   

  	
  2.3

  	
  Availability

  
	
   

  	
  2.4

  	
  Standards For Provision of
  Care

  
	
   

  	
  2.5

  	
  Providers Not Meeting Standards

  
	
   

  	
  2.6

  	
  Group Service Contracts

  
	
   

  	
  2.7

  	
  Quality
  Improvement/Case Management/Utilization Management Programs

  
	
   

  	
  2.8

  	
  Right to Re-Assign Members

  
	
   

  	
  2.9

  	
  Outpatient Drug Formulary and
  Pharmacy Information

  
	
   

  	
  2.10

  	
  Reciprocity

  
	
   

  	
  2.11

  	
  Termination
  of Physician/Patient Relationship

  
	
   

  	
  2.12

  	
  Encounter Data and Other Reporting

  
	
   

  	
  2.13

  	
  Disclosures

  
	
   

  	
  2.14

  	
  Direct Access Programs

  
	
   

  	
  2.15

  	
  Addition of New Plan Benefit Programs

  
	
   

  	
   

  	
   

  
	
  III.

  	
  PAYMENT OF PROVIDERS BY GROUP

  
	
   

  	
  3.1

  	
  Timely Group Payment

  
	
   

  	
  3.2

  	
  Failure To Make Payment

  

 

2

 

	
  IV.

  	
  PERFORMANCE OF DELEGATED FUNCTIONS

  
	
   

  	
  4.1

  	
  Delegation

  
	
   

  	
  4.2

  	
  Blue Shield Monitoring and Oversight

  
	
   

  	
  4.3

  	
  Termination of Delegation

  
	
   

  	
   

  	
   

  
	
  V.

  	
  OBLIGATIONS OF BLUE SHIELD

  
	
   

  	
  5.1

  	
  Directory and Use of Names

  
	
   

  	
  5.2

  	
  Provider Manual

  
	
   

  	
  5.3

  	
  Blue
  Shield Reports

  
	
   

  	
  5.4

  	
  Administrative Services

  
	
   

  	
   

  	
   

  
	
  VI.

  	
  ELIGIBILITY OF BLUE SHIELD MEMBERS

  
	
   

  	
  6.1

  	
  Identification Cards and Verification

  
	
   

  	
  6.2

  	
  Verification of Eligibility

  
	
   

  	
  6.3

  	
  Eligibility List and Modifications

  
	
   

  	
   

  	
   

  
	
  VII.

  	
  COMPENSATION & FINANCIAL TERMS

  
	
   

  	
  7.1

  	
  Capitation
  Payments

  
	
   

  	
  7.2

  	
  Services
  Other Than Capitated Professional Services

  
	
   

  	
  7.3

  	
  Copayments

  
	
   

  	
  7.4

  	
  Stop
  Loss Coverage

  
	
   

  	
  7.5

  	
  Shared
  Risk Program

  
	
   

  	
  7.6

  	
  Blue
  Shield POS Benefit Program

  
	
   

  	
  7.7

  	
  Third Party Liens

  
	
   

  	
  7.8

  	
  Groups Organized By Geographic Regions

  
	
   

  	
  7.9

  	
  Purpose of Incentive Programs

  
	
   

  	
  7.10

  	
  Blue Shield Timelines Guarantee

  
	
   

  	
  7.11

  	
  Encounter Data Submission Penalties

  
	
   

  	
   

  	
   

  
	
  VIII.

  	
  PROTECTION OF MEMBERS

  
	
   

  	
  8.1

  	
  Non Discrimination

  
	
   

  	
  8.2

  	
  Credentialed
  Providers

  
	
   

  	
  8.3

  	
  Charges
  to Members

  
	
   

  	
  8.4

  	
  Protection
  of Members

  
	
   

  	
  8.5

  	
  Benefits
  Determination

  
	
   

  	
  8.6

  	
  Member
  Complaints and Grievances

  
	
   

  	
  8.7

  	
  Medical
  Necessity Assistance

  
	
   

  	
  8.8

  	
  Free Exchange of Information

  
	
   

  	
  8.9

  	
  Insurance

  

 

3

 

	
  EXHIBIT A

  	
  Group Information and Benefit Programs

  
	
  EXHIBIT B

  	
  Division of Financial Responsibilities

  
	
  EXHIBIT C

  	
  Capitation

  
	
  EXHIBIT C-1

  	
  Capitation Rates

  
	
  EXHIBIT D

  	
  Shared Savings Programs

  
	
  EXHIBIT D-l -

  	
  Shared Savings Fund Allocations

  
	
  EXHIBIT D-2

  	
  Shared Savings Fund Allocations – Blue
  Shield 65 Plus

  
	
  EXHIBIT D-3

  	
  Pharmacy Shared Savings Fund Allocations

  
	
  EXHIBIT E

  	
  Blue Shield Allowable Rates

  
	
  EXHIBIT F

  	
  Delegation Responsibilities

  
	
   

  	
  Attachment
  I – Quality Management Requirements

  
	
   

  	
  Attachment II – Utilization
  Management Requirements

  
	
   

  	
  Attachment III –
  Credentialing/Delegation Requirements

  
	
   

  	
  Attachment IV – Claims
  Processing Requirements

  
	
  EXHIBIT G-l

  	
  Blue Shield 65 Plus Provisions

  
	
  EXHIBIT G-2

  	
  Blue Shield POS Provisions

  
	
  EXHIBIT H

  	
  Professional Stop Loss Program

  

 

4

 

HMO IPA/MEDICAL GROUP

SHARED SAVINGS PROVIDER AGREEMENT

 

This
Agreement is entered into between NORTHWEST
ORANGE COUNTY MEDICAL GROUP, a California corporation (hereinafter
“Group”), and California Physicians’ Service, Inc., d.b.a., Blue Shield of
California, a California nonprofit corporation (hereinafter “Blue
Shield”).  The Effective Date of this Agreement shall be February 1, 2003.

 

RECITALS

 

A.                                   Blue Shield is licensed as a prepaid health
care service plan under the Knox-Keene Act of 1975 (“the Knox-Keene Act”);

 

B.                                     Blue Shield contracts with individuals,
employer groups and governmental entities to provide or to arrange for the
provision of covered HMO health care services to Members of Blue Shield;

 

C.                                     Group is organized as a legal entity as
identified immediately following Group’s signature on this Agreement and is
licensed and qualified to provide or-arrange for the delivery of medical
services to Members of Blue Shield, either directly or through contracting
providers;

 

D.                                    Group and Blue Shield desire that Group
provide or arrange for the delivery of services to Members in accordance with
the terms of this Agreement;

 

E.                                      Except as specifically noted, this Agreement
is applicable to members enrolled under Blue Shield’s HMO Benefit Programs set
forth in Exhibit A, attached hereto. 
This Agreement shall only apply to Medicare beneficiaries enrolled in
Blue Shield’s Medicare+Choice program (“Blue Shield 65 Plus”) if such program
is specifically identified in Exhibit A. 
It is not intended to and does not supersede or amend any other
agreement under which Group or Group Providers provide professional services to
Blue Shield’s PPO Members.

 

I.  DEFINITIONS

 

For the purposes of this
Agreement, terms shall have the following meanings:

 

1.1                                 Agreement Year:  is the twelve month period beginning at
12:01 a.m, on the Effective Date of this Agreement, and on each anniversary of
the Effective Date.

 

1.2                                 Authorization:  is the procedure for obtaining the prior
approval of Blue Shield, or its delegatee (which may include Group), for the
provision or referral of Covered Services when such approval is required by
Blue Shield.

 

5

 

1.3                                 Benefit Program:  is a group or individual
prepaid HMO benefit program offered by Blue Shield through health services
contracts (and riders thereto).  The
Benefit Programs to which this Agreement applies are set forth in Exhibit A.
hereto.

 

1.4                                 Blue
Shield Providers(s):  are
those licensed healthcare providers, including acute care hospitals (“Blue
Shield Hospitals”), which have entered into agreements with Blue Shield to
provide Covered Services to Members.

 

1.5                                 Capitated
Professional Services:  are
those Covered Services which are described in Exhibit B. hereto as the
financial responsibility of Group. 
Capitated Professional Services also include any Covered Services which
are not listed in Exhibit B., but which are customarily provided by IPAs,
Medical Groups to their patients.  Blue
Shield may periodically amend Capitated Professional Services to include any
additional physician and/or ancillary services which must be provided by law.

 

1.6                                 Capitation:  is the monthly payment made by Blue Shield
to Group pursuant to Exhibit C. hereto, which payment, along with applicable
Copayments, is payment in full for all Capitated Professional Services to
Members.

 

1.7                                 Copayments:  refers to any copayments, deductibles, and
coinsurance which are specifically described as the financial responsibility of
the Member for a Covered Service in the applicable Health Services Contract
and/or Evidence of Coverage in effect as of the date of service.  Any other amount which Group or Group
Provider may seek to recover from Members for Covered Services constitutes a
surcharge and is prohibited by both this Agreement and by the Knox-Keene Act.

 

1.8                                 Covered
Services:  are
the Medically Necessary healthcare services which a Member is entitled to
receive pursuant to the Health Services Contract and Evidence of Coverage
applicable to the Member.  Except as
otherwise provided in the Member’s Health Services Contract and Evidence of
Coverage, Covered Services must generally be referred and authorized in
conformity with the Group’s and Blue Shield’s Utilization Management program.

 

1.9                                 Emergency Services:  are Covered Services to
address a medical condition manifesting itself by acute symptoms of sufficient
severity (including severe pain) so as to cause the prudent layperson to
conclude that the absence of immediate medical attention could reasonably be
expected to result in: (i) placing the Member’s health in serious jeopardy;
(ii) serious impairment to bodily functions; (c) serious dysfunction of any
bodily organ or part.  For Blue Shield
65 Plus Members, Emergency Services also include any other services defined as
emergency services in 42 C.F.R. §422.2.

 

1.10                           Evidence of Coverage:  is the document issued to the
Member pursuant to California law which describes the benefits, limitations and
other features of the Benefit Program in which the Member is enrolled.

 

6

 

1.11                           Group Provider:  is a physician (“Group Physician”),
ancillary provider, or other provider with whom Group has entered into a
contract for the provision of Capitated Professional Services.

 

1.12                           Group Service Area:  is that aggregate geographic
area determined by and located within a thirty (30) mile radius from Group’s
PCP designated participating hospitals and including all zip codes containing a
participating PCP facility.  A PCP facility
refers to the Group’s principal and satellite offices, if an integrated medical
group, and to the offices of each of its contracted or employed PCPs, if an IPA
or medical foundation.  The zip codes
describing the location of Group’s PCP facilities are set forth in Exhibit A.,
attached hereto.  If subsequent to the
Effective Date of this Agreement, Group adds a new PCP, the Service Area and
zip code list in Exhibit A. shall be automatically amended if necessary to
include the zip code in which the PCP facility is located.  The Group Service Area shall be used to
determine in-area from out-of-area services and to proscribe the maximum area
in which Member’s who select a Group PCP must live or work.

 

1.13                           Health
Services Contract:  is
the group or individual contract, applicable to the Member, which sets forth
the Benefit Program and the Covered Services to which the Member is entitled,
as well as the Member’s Copayment obligation.

 

1.14                           Medically Necessary:  services or supplies means
those medical services and supplies which are provided in accordance with
recognized professional medical and surgical practices and standards which are
determined to be: (a) appropriate and necessary for the symptoms, diagnosis or
treatment of the Member’s medical condition; and (b) provided for the diagnosis
and direct care and treatment of such medical condition; and (c) not furnished
primarily for the convenience of the Member, the Member’s family, or the
treating provider or other provider; and (d) furnished at the most appropriate
level which can be provided consistent with generally accepted medical
standards of care; and (e) consistent with Blue Shield Medical Policy.

 

1.15                           Member:  is an individual who is, according to Blue
Shield’s rules and policies, eligible for and enrolled (or otherwise covered by
Blue Shield as a newborn) in a Blue Shield Benefit Program described in Exhibit
A., and who has selected or been assigned (either prospectively or
retroactively) to a Group Primary Care Physician as his/her primary care
physician.  Blue Shield retains final
authority to determine whether an individual is or is not a Member assigned to
a Group PCP.

 

1.16                           Primary
Care Physician (PCP):  is
a family practitioner, general practitioner, internist, or pediatrician who has
been employed or contracted by Group to provide primary care services to
Members and to be responsible for coordinating, referring, and managing the
delivery of Covered Services to the Member. 
A PCP shall include an obstetrician-gynecologist who is qualified and
has agreed with Group to serve as a PCP, and may also include other specialists
if approved in writing by Blue Shield.

 

1.17                           Provider Manual:  refers to the manuals
developed by Blue Shield which set forth the operational rules and procedures
applicable to the Group and Group Providers. 
The

 

7

 

Provider
Manual will include the HMO Provider Manual, the HMO Benefit Guidelines and the
Blue Shield Medical Policy Manual.

 

1.18                           Shared Savings Services:  refer to the Covered Services
which are not Capitated Professional Services and as to which the Group and
Blue Shield share financial responsibility under the Shared Savings Settlement
set forth in Exhibit D.

 

1.19                           Urgent Care Services:  are those Covered Services
(other than Emergency Services) which are Medically Necessary to prevent
serious deterioration of a Member’s health, alleviate severe pain, or treat an
illness or injury with respect to which treatment can not reasonably be
delayed.  For Blue Shield 65 Plus
Members, Urgent Care Services, at a minimum, include all services which are
defined by Center for Medicare and Medicaid Services (CMS) as “Urgently Needed
Services”.

 

II.  OBLIGATIONS OF GROUP

 

2.1                                 Capitated Professional Services. 
Group shall provide or arrange for the provision of all Medically
Necessary Capitated Professional Services to Members and shall be fully
financially responsible for same.  Such
services shall be provided through Group Providers who have been credentialed
as required by this Agreement and as more fully described in the Provider
Manual.  Without limiting the foregoing,
Group shall: (i) be financially responsible for Emergency and Urgent Care
Services provided by healthcare providers in addition to Group Providers, as
set forth in Exhibit B., (ii) refer Members, at Group’s cost and when Group
Providers are not available to provide Medically Necessary Capitated Services,
to non-Group Providers; (iii) provide all preventive health services to which a
Member is entitled under his/her Benefit Plan; and, (iv) make available to
Members those health education programs routinely provided by Group and Group
Providers at no charge to their patients.

 

2.2                                 Referrals For Other Covered Services.

 

(a)                                  Subject to applicable Authorization requirements
set forth in the Provider Manual, Group shall, as Medically Necessary, refer
Members to Blue Shield Providers (including Blue Shield Hospitals) for those
services which are Covered Services but which are not Capitated Professional
Services.  Upon and following such
referral, Group shall coordinate the provision of such Covered Services to
Members and ensure continuity of care.

 

(b)                                 Group shall utilize the organ transplant
provider network established by Blue Shield for the provision of selected organ
transplants.  Blue Shield shall, from
time to time, designate which transplant centers are to be utilized for
specified transplants.

 

(c)                                  In addition, upon notice by Blue Shield to
Group that Blue Shield has developed other specialty networks for the provision
of Covered Services that are not Capitated Professional Services, Group shall
utilize such applicable

 

8

 

specialty
network(s) for the provision of such services to Members, unless (except for
the organ transplant provider network referred to above) Group demonstrates to
Blue Shield’s reasonable satisfaction that Group Providers are able to offer
comparable services of comparable quality and cost effectiveness to the
services to be offered by Blue Shield’s specialty network.

 

2.3                                 Availability.

 

(a)                                  Group shall ensure that routine Capitated
Professional Services shall be available to Members during normal physician
business hours (generally, Monday through Friday, 9:00 a.m. to 5:00 p.m.) and
Emergency Services and telephone advice and referral shall be available, as
Medically Necessary, twenty-four (24) hours per day, seven (7) days per week,
three hundred sixty five (365) days per year. 
Appointment, scheduling, and office waiting times shall be within the applicable
guidelines set forth in the Provider Manual. 
Capitated Professional Services shall at all times during the term of
this Agreement be made readily available through PCP facilities located in the
zip code areas set forth in Exhibit A.

 

(b)                                 Group shall ensure that each Group Physician
maintains adequate on-call coverage arrangements with another Group Physician
to provide coverage for Members when that Group Physician is temporarily
unavailable.  The provision of services
to Members by the on-call Group Physician shall be governed by the terms of
this Agreement.

 

(c)                                  Group and Group Providers shall participate
in all Benefit Programs set forth in Exhibit A. Except for those PCPs who
generally only serve, or generally do not serve, geriatric patients in their
practices, or pediatricians who serve only pediatric patients, or OB/GYNs who
serve only female patients, Group shall ensure that each of its PCPs accepts
all of the Members who select them during such times that such PCP’s practice
is open to new patients.

 

(d)                                 Group shall ensure that at any given time,
the practices of an adequate number of its PCPs are open to Members to meet all
access standards required by Blue Shield, and its regulatory agencies.  Each PCP, whether or not his/her practice is
closed to new patients, shall accept each Member (and such Member’s immediate
family members) who is or had been a patient of PCP at anytime during the two
(2) years immediately prior to such Member selecting physician as his/her PCP.  Without limiting the foregoing, Group shall
ensure that at anytime that a PCP is accepting new patients of other health
care service plans, such PCP accepts Members hereunder.  In the event a PCP, during the term of this
Agreement, elects to close his/her practice to new Members, or cease to be a
Group Provider, Group shall give Blue Shield sixty (60) days prior written
notice of such closure.

 

(e)                                  Group acknowledges that Blue Shield retains
full authority to develop and periodically modify its procedures for Member PCP
selection and the

 

9

 

 

assignment
of the Member to a Medical Group when the selected PCP is in multiple medical
groups. Group and its Group Providers shall cooperate with Blue Shield’s Member
PCP selection process and shall assist Members in selecting a PCP when
requested to do so by the Member or Blue Shield.

 

(f)                                    In providing Capitated Professional Services
hereunder, Group shall comply with all obligations of state and federal law
relating to continuity of care and continued access to terminated providers.

 

(g)                                 Group shall, at all times during the term of
this Agreement, maintain an adequate network of Group Providers in number and
type to comply with the requirements of state and federal law and to ensure
that Members have timely and reasonable access to primary, specialty and
ancillary care, as set forth in the Provider Manual.  All providers who are designated as Group Providers by Group and
are communicated to be such by Group to Blue Shield shall at all times be
reasonably available to Members as is appropriate.

 

2.4                                 Standards
For Provision of Care.

 

(a)                                  Group and Group Providers shall maintain
facilities and equipment which meet all applicable legal requirements,
including accessibility, and which otherwise comply with the provider
credentialing requirements developed by Blue Shield for such providers, as more
fully described in the Provider Manual. 
Accessibility shall include compliance with the requirements of the Americans
With Disabilities Act.

 

(b)                                 To assist Group in meeting Blue Shield
requirements hereunder, Group shall, through a duly designated representative,
attend occasional provider education/orientation sessions conducted by Blue
Shield.

 

(c)                                  In providing Capitated Professional Services
hereunder Group shall utilize only Group Providers who are credentialed and
re-credentialed in accordance with Blue Shield’s standards as set forth in the
Provider Manual, unless the Medically Necessary service is not available from a
Group Provider.  Group and/or each Group
Provider shall provide to Blue Shield, on request, credentialing information,
in such form as reasonably required by Blue Shield.

 

(d)                                 Group represents and warrants that during the
term of this Agreement, each physician through whom it will provide Capitated
Professional Services hereunder shall: 
(i) maintain a current, unrestricted license to practice medicine in
California; and, (ii) maintain such staff privileges with at least one Blue
Shield Hospital as necessary for physician to provide services to Members
hereunder; and, (iii) be certified and eligible to participate in the Medicare
Program.  Group further represents and
warrants that: (iv) each non-physician Group Provider shall maintain a current and
unrestricted license to practice his/her profession or provide the contracted
service; and, (v) use of

 

10

 

any
physician extender shall be in strict compliance with the rules of the
California Medical Board.

 

(e)                                  Each Group Physician shall authorize each
hospital at which he/she maintains staff privileges to notify Blue Shield
should any disciplinary or other action of any kind be initiated against such
physician which could result in any suspension, reduction, or modification of
his/her hospital privileges.

 

2.5                                 Providers Not Meeting Standards. 
Group shall promptly notify Blue Shield as of the date Group knows that
a Group Physician no longer meets any of Blue Shield’s credentialing criteria
as set forth in the Provider Manual.

 

2.6                                 Group Service Contracts.  Group shall provide to Blue
Shield a written list of its Group Providers, and each month notify Blue Shield
of any additions or deletions to such list (including any notices of
termination of Group Providers), in addition to which Group shall provide Blue
Shield with immediate notice of termination of Group Providers.  Further, Group shall provide timely response
to reasonable periodic requests from Blue Shield for verification of the
current list of Group Providers. 
Group’s contracts with Group Providers shall be in writing and shall
ensure that such providers: (a) seek payment for the provided services only
from Group and under no circumstances seek payment from the Member or from Blue
Shield; (b) under no circumstances balance bill or surcharge Members for
Covered Services (including in the event of Group and/or Blue Shield’s
insolvency); (c) maintain and disclose such records to Blue Shield and to
Governmental Officials as set forth in Article IX hereof; (d) permit Government
Officials and Blue Shield to inspect its offices, records, and facilities as
set forth in Article X; (e) cooperate with and participate in Blue Shield’s and
Group’s quality improvement and utilization management programs and Member
grievance and appeal procedures; and, (f) maintain such professional and
general business liability insurance as set forth in Article VIII hereof.  Upon Blue Shield’s request, Group’s form of
provider contract(s), along with the executed signature pages to such
contracts, shall be provided to Blue Shield. 
Group may maintain the confidentiality of its payment rates (other than
bonus/withhold/shared risk or savings arrangements), provided that such does
not result in concealment or misunderstanding of other terms and provisions of
the contract.  Upon Blue Shield’s
request, such contracts shall be promptly amended to contain any provisions
required to be contained in provider contracts by either the Department of
Corporations (“DMHC”), CMS, or any other governmental agency.

 

2.7                                 Quality
Improvement/ Case
Management/ Utilization Management Programs.  Group and Group Providers
shall fully cooperate with and participate in Blue Shield’s quality improvement
and utilization management programs, including its peer review functions,
authorization procedures, and quality improvement committees, as described in
the Provider Manual.  Group shall
immediately notify Blue Shield of those Members and cases which Group has
identified as requiring additional resources and case management (see Provider
Manual for commonly referred diagnoses and conditions) and shall cooperate in
the management of these cases.  Group
and Group Providers shall fully cooperate with Blue Shield with regard to the
Health Employer

 

11

 

Data
Information Sets (HEDIS) measurements and HEDIS audits, guideline development,
preventive services utilization, disease/risk management, clinical service
monitoring and quality improvement studies and initiatives.  Group and Group Providers shall comply with
Blue Shield’s Medical Policy.  The
quality improvement and quality management obligations of Blue Shield are not
delegated to Group; however, Group shall have its own fully functional Quality
Management Program, as described in Attachment 1 to Exhibit F hereto, that is
cooperative with and integrated into the Blue Shield Quality Management
Program.  Group shall comply with and
accept as final, the decisions of the Blue Shield quality improvement and
utilization management program, and pending resolution of any dispute through
the dispute resolution process, comply with the decisions of the Blue Shield
quality improvement and utilization management program.

 

2.8                                 Right to
Re-Assign Members. 
Blue Shield reserves the right to re-assign Members from Group to
another medical group contracting with Blue Shield, or from a Group Physician
to another Group Physician, or to limit or deny the assignment or selection of
new Members to Group or a Group Physician Provider: (i) during any termination
notice period; or (ii) if Blue Shield determines that Capitated Professional
Services are not being properly provided to, or arranged for, such Members as
required by this Agreement and that such failure poses an immediate threat to
the Members health and safety.  In the
event that Blue Shield takes any action permitted by this Paragraph 2.8, this
Agreement shall continue in effect unless terminated by either party as set
forth in Article XII of the Agreement.

 

2.9                                 Outpatient
Drug Formulary and
Pharmacy Information.

 

(a)                                  Group and Group Providers shall comply with
the outpatient drug formulary, drug prior authorization requirements, and
pharmacy benefit design (including maximum supplies, use of generics, and mail
order for maintenance drugs), as adopted and periodically modified by Blue
Shield and as set forth in the Provider Manual.

 

(b)                                 In the event that Blue Shield provides to
Group computerized or electronic data regarding prescriptions obtained by
Members and drugs supplied, Group agrees that such information is provided for
the limited and restricted purpose of utilization management.  Under no circumstances may Group copy or
share such data with others, or utilize such data, in whole or in part,
directly or indirectly, to negotiate rebates, discounts, or contracts with pharmaceutical
manufacturers or other suppliers of pharmaceuticals.

 

(c)                                  Group acknowledges that Blue Shield and its
designees retain sole authority to perform, in relationship to outpatient
pharmacy, claims processing, formulary development, a prior authorization
program, selection and contracting of a pharmacy network, and determination of
pharmacy benefit design.

 

12

 

2.10                           Reciprocity.

 

(a)                                  Group shall participate in the statewide Blue
Shield health services delivery network and shall accept referrals of Blue
Shield members (members of Blue Shield who are not Members hereunder) and/or
provide Emergency Services to such members, when such members are the financial
responsibility of other Blue Shield medical groups.  Except as Group and the other medical group to which such Blue
Shield member is assigned agree, Group shall accept as compensation for such
services, the rates set forth in Exhibit E. (the “Blue Shield Allowable
Rates”)  minus the Blue Shield member’s
applicable Copayment.

 

(b)                                 In the event that a Member receives Emergency
Services or Urgent Care Services from or Group refers a Member for Capitated
Professional Services to a healthcare provider who is neither a Group Provider
nor a provider who is obligated to accept the compensation described in subpart
(a) above, but with whom Blue Shield has negotiated compensation rates, then
Blue Shield, at Group’s request, may compensate such provider for the Capitated
Professional Services provided to the Member and deduct the amount of such
payment from any amount then or thereafter owed by Blue Shield to Group.  This provision is intended for specific
occasional services only and Blue Shield shall have no obligation hereunder to
compensate providers contracted to Group in the event of Group’s default in
compensating such providers.

 

(c)                                  Affiliates.  In the event that Group or a
Group Provider provides services to an individual who is not a member of Blue
Shield, but who is entitled to coverage for or payment of the services so
provided by virtue of enrollment in a health plan of an Affiliate of Blue
Shield, then Group and Group Providers agree to render services and to accept
payment of the Blue Shield Allowable Rates (Exhibit E.) from the Affiliate as
full and complete payment for such services less any copayment, coinsurance or
deductible owed by the individual under the Affiliate health plan.  Group agrees to look solely to the Affiliate
and not to Blue Shield for payment for such services.  For purposes of this Paragraph, “Affiliate” means an organization
that is: (i) wholly owned by Blue Shield, or, (ii) under common ownership or
control with Blue Shield (a sister corporation), or, (iii) a joint venturer
with Blue Shield in an enterprise under which the Affiliate is obligated to
provide coverage for/pay for the services in question.

 

2.11                           Termination
of Physician/Patient
Relationship.

 

(a)                                  Group or a Group Provider may terminate the
professional relationship with a Member only with Blue Shield’s consent and in
accordance with the procedures set forth in the Provider Manual.  In the event a Group Provider terminates
his/her relationship with a Member, Group shall assist the Member in selecting
another Group Provider for the provision of Capitated Professional Services.

 

13

 

(b)                                 In no event may either Group or a Group
Provider terminate the professional relationship with a Member because of such
Member’s medical condition, or the amount, variety, or cost of Covered Services
that are required by the Member.

 

(c)                                  Group acknowledges that a Member may request
transfer between PCPs, and between Blue Shield medical groups, in accordance
with the Member’s applicable Health Services Contract and Evidence of
Coverage.  As appropriate, Group agrees
to accept the transfer of a Blue Shield member to Group at the request of Blue
Shield.

 

(d)                                 Notwithstanding the foregoing, when the
consent of CMS or any other governmental agency to the termination of a
physician-patient relationship is required pursuant to the rules and
regulations governing the Medicare Program or any other governmental program,
neither Group nor a Group Provider may terminate the physician-patient
relationship with a Blue Shield 65 Plus Member or such other Member without
first obtaining the consent of Blue Shield, CMS, or as applicable, the other
governmental agency.

 

2.12                           Encounter Data and Other Reporting. 
Group shall submit to Blue Shield such encounter/claims data (“Encounter
Data”) as set forth in and in accordance with the requirements set forth in the
Provider Manual.  Group also shall
provide to Blue Shield such data regarding Group turn-around time for
authorizations and other administrative services as set forth in the Provider
Manual.

 

2.13                           Disclosures.

 

(a)                                  In addition to the notice obligation set
forth in Paragraph 2.5, Group shall notify Blue Shield immediately in writing
when it becomes aware of the occurrence of any of the following events: (i)
Group’s or a Group Provider’s liability insurance is canceled, terminated, not
renewed, or materially modified; (ii) Group or a Group Provider has become a
defendant in a lawsuit filed by a Member or is required or agrees to pay
damages to a Member for any reason; (iii) an act of nature or any event occurs
which has a materially adverse effect on Group’s ability to perform its
obligations hereunder; (iv) a petition is filed to declare Group bankrupt or
for reorganization under the bankruptcy laws of the United States or a receiver
is appointed over all or any portion of the Group’s assets; or (v) Group is
sued, or suit is threatened in writing, by a healthcare provider for nonpayment
of compensation; or (vi) any other situation arises which could reasonably be
expected to materially affect Group’s ability to carry out its obligations
under this Agreement.  Group shall also
provide Plan with thirty (30) days’ advance notice of any proposed material
change in the ownership of Group, a change in its management services organization
(if any), or the sale of all or substantially all of the assets of the Group
and obtain Plan’s prior approval of same, which approval shall not be
unreasonably withheld.

 

14

 

(b)                                 Annually, within sixty (60) days following
the end of Group’s fiscal year or thirty days following such information being
available to Group, Group shall provide to Blue Shield a copy of its most
recent annual income statement, balance sheet, and statement of cash flow,
which shall be prepared in accordance with generally accepted accounting
principles and shall be certified by Group’s chief executive officer or chief
financial officer.  Group shall provide
a copy of any audited financial statements it may have to Blue Shield.  A narrative or work sheet describing the
calculation of Group’s IBNR shall accompany the submitted financial
statements.  The information set forth
in this paragraph shall also be provided by Group to Blue Shield in the event
there is an actual or proposed change in ownership of Group.  Group shall also, upon request, provide Blue
Shield with copies of quarterly financial statements, which shall include a
balance sheet, statement of income and statement of cash flow prepared in
accordance with generally accepted accounting principles.

 

(c)                                  Group shall provide Blue Shield with monthly
claims reports required by Blue Shield in order to comply with state and
federal law and to ensure compliance by Group with the requirements of Article
III. hereof.

 

(d)                                 Blue Shield agrees that it shall treat as confidential
all financial information provided by Group in accordance with subparts (b) and
(c) of this section unless such information is publicly available, and shall
not disclose such information to others except as required by law or as
requested by Blue Shield’s regulators.

 

2.14                           Direct Access Programs.  Group shall participate in
and comply with the Access+ and CareDirect program requirements as set forth in
the Provider Manual.

 

2.15                       Addition
of New Plan
Benefit Programs.  In the event that Blue Shield develops one
or more new Benefit Programs and requests that Group agree to amend this
Agreement to add such new Benefit Program(s) to this Agreement, Group shall in
good faith consider such request and make best efforts to resolve all matters
(including the new Benefit Program compensation) so that a finalized amendment
to this Agreement may be executed within thirty (30) days of Blue Shield’s
request.

 

2.16                           Acceptance of Members. 
Group shall accept all Members who select or who are assigned to Group
or Group PCPs and who live or work within the Group Service Area.  This requirement shall not apply to Members
with whom the Group’s relationship was terminated in accordance with section
2.11 hereof. Blue Shield shall undertake reasonable efforts in accordance with
a standard of good faith to assure that Members who select or are assigned to
Group or Group PCPs live or work within the Group Service Area.

 

15

 

III. PAYMENT OF
PROVIDERS BY GROUP

 

3.1                                 Timely Group Payment.  Group shall process claims
from and pay its Group Providers and other healthcare providers for Capitated
Professional Services (including without limitation the Emergency Services or
Urgent Care Services which are Group’s responsibility hereunder) in a timely
fashion as set forth in Paragraph 13.4 hereof. 
If Group delegates to a subcontractor (either a management company,
claims administrator, subcontracted capitated provider, etc.) the obligation to
process claims on Group’s behalf, then Group shall: (i) immediately notify Blue
Shield of such delegation, including any change in the delegated entity, and,
(ii) require that the subcontractor comply with the claims payment procedure
requirements set forth in this Agreement.

 

3.2                                 Failure To Make Payment.

 

(a)                                  In the event that Group occasionally fails to
pay a Group Provider or other healthcare provider for Capitated Professional
Services within the time frames set forth in this Agreement, and Blue Shield
reasonably determines that such amount is due and payable by Group, Blue Shield
may, after notice to Group, pay the amount due, and deduct and offset such
payment from any amount then or thereafter payable by Blue Shield to Group.

 

(b)                                 In the event of Group’s continued or repeated
failure to compensate Group Providers or other healthcare providers within the
time limits required by this Agreement as set forth in Section 13.4, Blue
Shield may elect to pay claims on behalf of Group and offset the amount of such
payments, along with a monthly administrative fee (not to exceed 10% of monthly
Capitation) from any amounts then or thereafter owed by Blue Shield to Group,
including capitation.  Prior to any such
action, Blue Shield shall have provided Group with written notice of the
repeated failures and an opportunity to cure the noncompliance.

 

(c)                                  Group acknowledges that any such direct
payments to Group Providers by Blue Shield constitute partial mitigation of
damages incurred by Blue Shield for Group’s failure to perform its obligations
under this Agreement.

 

IV.  PERFORMANCE OF DELEGATED FUNCTIONS

 

4.1                                 Delegation.  Blue Shield delegates to Group the
responsibilities set forth in Exhibit F. attached hereto, and Group agrees to
accept and perform such delegated responsibilities in full compliance with the
delegation criteria and standards for performance of delegated activities set
forth in Exhibit F. and the Provider Manual. 
Responsibility for all functions not so delegated is retained by Blue
Shield.  With respect to matters
delegated, Blue Shield retains final authority and responsibility, including
without limitation, the determination of the Medical Necessity of Covered

 

16

 

Services,
the determination as to which services are Covered Services, and the determination
as to who is or is not a Member.

 

4.2                                 Blue
Shield Monitoring and Oversight. 
Group acknowledges Blue Shield’s responsibility to monitor Group’s
compliance with the delegation criteria and standards and agrees to cooperate
with Blue Shield’s monitoring of such compliance, as set forth in Exhibit F.
and the Provider Manual.

 

4.3                                 Termination
of Delegation.

 

(a)                                  In the event that Blue Shield is dissatisfied
for any reason with Group’s performance of delegated activities, Blue Shield
may, in its sole discretion, modify Group’s status (with respect to all or a
particular delegated activity) from fully delegated to delegated with
corrective action.  Such notice of
delegation with corrective action shall set forth the deficiencies perceived by
Blue Shield in Group’s performance of delegated activities, and Group shall
have ninety (90) days to correct such deficiencies to the reasonable
satisfaction of Blue Shield.  In the
event such deficiencies are not corrected to the reasonable satisfaction of
Blue Shield, Blue Shield may, in its sole discretion, terminate the delegation
or extend the period given Group to correct such deficiencies.

 

(b)                                 In lieu of the notice of delegation with
corrective action and opportunity to correct deficiencies, as set forth in Paragraph
4.3(a) above, Blue Shield may at anytime within its sole discretion, terminate
all or portions of the delegation granted to Group hereunder by providing no
less than sixty (60) days prior written notice.  Blue Shield may also terminate all or portions of the delegation
granted to Group hereunder if Blue Shield determines, after consultation with
Group, that Group either no longer meets all criteria or is not performing (or
is reasonably not likely to perform) the delegated activities in full compliance
with the standards.  In such event, Blue
Shield shall give to Group no less than thirty (30) days prior notice of such
termination of delegation, and if Group, during such notice period, cures such
deficiencies to Blue Shield’s reasonable satisfaction, Blue Shield may, in its
sole discretion, withdraw such termination. 
The reduction amount set forth in Exhibit F. is intended solely as a
penalty and will cease when Group has demonstrated successful implementation of
the corrective action plan.

 

(c)                                  Upon termination of all or part of the
delegation pursuant to this Article IV, Blue Shield may, in its sole
discretion, reduce the Capitation amount otherwise payable to Group hereunder
by a per member amount as set forth in Exhibit F. for each delegated service,
which amount is not intended to represent the portion of the capitation amounts
that are allocated to cover the cost of performance of the delegate service by
Group nor an estimate of the costs incurred by Blue Shield as a result of the
termination of such delegation; rather, the amounts set forth in Exhibit F. are
intended as a penalty for Group’s

 

17

 

failure
to meet the standards established for performance of the delegated service.

 

V.  OBLIGATIONS OF BLUE SHIELD

 

5.1                                 Directory
and Use of Names.

 

(a)                                  Blue Shield shall develop a directory of
Primary Care Physicians and certain specialists and other healthcare providers
participating in Blue Shield which shall be distributed to Members.  Blue Shield may provide a draft of such
directory to Group and Group may, within five (5) working days thereafter,
submit to Blue Shield, any additions, deletions, or modifications to be
included in the directory.  Group, on
behalf of itself and each of its Group Providers, agrees that the following
information may be included in Blue Shield’s marketing materials, Blue Shield
publications provided to present or potential Members and subscriber groups,
and in other written or electronic information sources provided to present or
potential Members and subscriber groups: (i) Group’s name, address, phone
number; (ii) the names, addresses, phone numbers, areas of practice of its
Group Providers (and other provider specific information); and, (iii) such
other types of information regarding Group and Group Providers which are
reasonable to include in directories, marketing materials, or publications.
Group and Group Providers agree that in the event this Agreement is terminated,
or the listing information is or becomes incorrect or incomplete, Blue Shield
will have no obligation to correct, delete, or update such listing information
until such time as Blue Shield, in its sole discretion, issues a new directory,
marketing material, or Blue Shield publication.

 

(b)                                 Except as provided in subpart (a) above,
neither Blue Shield nor Group shall use the other’s name, trademark(s), or
service mark(s), without the other’s prior written consent, which consent shall
not be unreasonably withheld.

 

5.2                                 Provider Manual.  Blue Shield shall develop a
Provider Manual, and Group and Group Providers shall comply with its
provisions.  Blue Shield may, in its
discretion, periodically modify the Provider Manual by written notice to Group.  The Provider Manual, as so amended, is
incorporated herein by reference.  To
the extent of any conflict between this Agreement and the Provider Manual, the
terms of this Agreement shall govern. 
In the event Group reasonably concludes that a change in the Provider
Manual would have an adverse financial impact on the Group, then Group and Blue
Shield shall confer in good faith regarding the change.

 

5.3                                 Blue Shield Reports.  Blue Shield shall provide to
Group such reports regarding utilization and other matters as set forth from
time to time in the Provider Manual.

 

5.4                                 Administrative
Services. 
Blue Shield shall perform those services incident to the administration
of a health care service plan including, but not limited to, the

 

18

 

processing
of enrollment applications, assignment of Members to PCPs, and the
administration of claims for Covered Services which are not Capitated
Professional Services or Capitated Hospital Services.

 

VI.  ELIGIBILITY OF BLUE SHIELD MEMBERS

 

6.1                                 Identification
Cards and
Verification.  Blue Shield shall issue identification cards
to Members as set forth in the Provider Manual.  Production of such identification cards shall be indicative of a
person’s status as a Member, but shall not be conclusive of such status.  Blue Shield shall provide or shall make
available to Group in formats that may be accessed by Group electronically or
telephonically, information regarding Member status and Group/Primary Care
Physician selection.

 

6.2                                 Verification
of Eligibility.  As
set forth in the Provider Manual, Group and Group Providers shall verify the
eligibility of Members and provide services to individuals claiming eligibility
but whose name does not appear on Blue Shield’s Eligibility List.  Verification of eligibility shall not limit
the rights of Blue Shield to retroactively adjust eligibility, as set forth in
Paragraph 6.3 of this Agreement.

 

6.3                                 Eligibility
List and Modifications.

 

(a)                                  Blue Shield shall provide to Group on a
monthly basis within ten days of the start of the month, a member eligibility
report and a member eligibility change report, as further described in the
Provider Manual.  These reports shall be
submitted to the Group electronically, unless both Blue Shield and the Group
agree that it may be submitted in writing. 
Blue Shield shall attempt to discourage retroactive cancellation or
retroactive addition of Members. 
However, Blue Shield may make exceptions as may be necessary for
administrative or business reasons. 
Subsequent Capitation to Group will be adjusted to reflect the
retroactive addition or deletion of Members. 
With the exception of retroactive changes for Members enrolled in Blue
Shield 65 Plus and those Members enrolled through CalPERS and FEHBP,
retroactive additions or deletions shall not exceed ninety (90) days.

 

(b)                                 In the event Blue Shield retroactively
deletes a Member and Group has provided Capitated Services to such deleted
Member during the period of retroactive deletion, Blue Shield shall compensate
Group for such services only if Group has unsuccessfully billed the Member
through two (2) billing cycles.  The
amount owed by Blue Shield for such Covered Services provided during the period
of retroactive deletion shall be the Blue Shield Allowable Rates set forth in
Exhibit E., net of any Copayments. 
Notwithstanding the foregoing, Blue Shield shall have no obligation to
compensate Group for such services in the event that such Member is covered
during the period of retroactive deletion by another health care service plan,
insurer, or third party payor (including Medicare).

 

19

 

(c)                                  In the event a person is retroactively added
as a Member, Blue Shield’s financial responsibility shall be the payment of
Capitation for the period of retroactive addition.  Any payments collected from such Member by Group or Group
Providers for Covered Services hereunder, other than applicable Copayments,
shall be refunded to the Member.

 

VII.  COMPENSATION & FINANCIAL TERMS

 

7.1                                 Capitation Payments.

 

(a)                                  Blue Shield shall pay Group, on a monthly basis,
the applicable Capitation set forth in Exhibit C. Such Capitation shall be paid
for Members not enrolled in the Blue Shield 65 Plus Benefit Program no later
than the twentieth (20th) day of the month. 
Capitation shall be paid for Members who are enrolled in Blue Shield’s
Blue Shield 65 Plus Benefit Program no later than the later occurring of the
twentieth (20th) day of the month or five (5) business days following the date
Blue Shield receives the CMS capitation payment for such Members.

 

(b)                                 Medicare Primary.  For
those Members for whom Medicare is primary, Group or Group Providers shall bill
Medicare as the primary payor for Medicare covered benefits.  For such Members, Blue Shield shall pay. a
reduced Capitation as set forth in Exhibit C., and Group shall be financially
responsible for all Capitated Professional Services (including those which are
not Medicare benefits) which are Covered Services for said Members.  In addition, neither Group nor Group Providers
may charge or collect from such Members the Member’s Medicare coinsurance and
deductible.  The Medicare Primary
Member, however, shall be responsible for his/her applicable Copayment set
forth in the applicable Health Services Contract and Evidence of Coverage.

 

(c)                                  The Capitation paid shall be for all Members
eligible on the first (1st) day of the month for which the Capitation is to be
paid, who have chosen a Group physician as their PCP.  Group shall accept payment of Capitation in accordance with this
Agreement, and applicable Copayments and coordination of benefits collections,
as payment in full for all Capitated Professional Services, administrative
services, and other services rendered by Group pursuant to this Agreement.

 

(d)                                 In the event this Agreement terminates on a
day other than the last day of a month, Blue Shield may pro-rate the Capitation
due for said month based on the number of days in said month covered by the
Agreement to the total number of calendar days in said month.

 

20

 

7.2                                 Services Other
Than Capitated
Professional Services.

 

(a)                                  In the event that Group provides Emergency
Services, Urgent Care Services, or authorized Covered Services to Blue Shield’s
HMO members who are not Members hereunder (and for whom such services are not
the financial responsibility of another capitated Blue Shield medical group),
Group shall bill Blue Shield for the provision of such services as set forth in
the Provider Manual.  Blue Shield shall
pay Group for the services described in this Paragraph 7.2 at the rates set
forth in Exhibit E., minus any applicable Copayment.  All such billings shall be delivered to Blue Shield within sixty
(60) days of the date of service. Blue Shield may deny payment for any bills
not received by Blue Shield within one hundred eighty (180) days of the date of
service and in such event, neither Group nor Group Providers may bill the
Member for such services.

 

(b)                                 Notwithstanding the foregoing subpart (a), in
the event that Blue Shield is not the primary payor, Group shall not make any
demand for payment from Blue Shield until all primary sources of payment have
been pursued.  Blue Shield’s obligation
hereunder with respect to such Covered Services provided to members who are not
Members hereunder, shall be limited to the amount, if any, which when added to
the amount obtained by Group from such primary payors, equals the amount of
compensation to which Group is entitled under this Agreement for such services.

 

7.3                                 Copayments.  Group shall collect and
retain, as additional compensation, the Member’s applicable Copayment for
Covered Services provided. Such Copayment obligation shall not be waived by
Group or Group Providers.

 

7.4                                 Stop Loss Coverage.  During the term of this
Agreement, Group shall either obtain professional stop loss coverage through
Blue Shield under the terms and conditions set forth in Exhibit H attached
hereto or shall obtain professional stop loss coverage from a third party
insurer acceptable to Blue Shield.  Upon
request, certificates and other proof of such coverage shall be provided to
Blue Shield. Group shall provide Blue Shield with timely notice of cancellation
of coverage or change in carrier.  If
Group elects to have Blue Shield provide such stop loss coverage, by so
indicating on the Signature Page hereto, Blue Shield shall provide and charge
Group for stop loss coverage as set forth in Exhibit H.

 

7.5                                 Shared Savings
Programs.

 

(a)                                  Blue Shield shall establish a Shared Savings
Program pursuant to which Blue Shield and Group share savings for the cost of
Covered Shared Savings Services provided to Members during the Agreement
Year.  The provisions of the Shared
Savings Program for Members who are enrolled in Benefit Programs other than
Blue Shield 65 Plus are set forth in Part A of Exhibit D. The provisions of the
Shared Savings Program for Blue Shield 65 Plus Members are set forth in Part B
of Exhibit D.

 

21

 

(b)                                 Blue Shield shall establish a Pharmacy Shared
Savings Fund Program pursuant to which Blue Shield and Group share savings for
the cost of Covered Outpatient Prescription Drug services provided to Blue
Shield 65 Plus Members during the Agreement Year.  The provisions of the Pharmacy Shared Savings Fund Program are
set forth in Part C. of Exhibit D.

 

(c)                                  Blue Shield may offset any amount owed to
Blue Shield by Group under a Shared Savings Program, Pharmacy Shared Savings
Fund, or other risk sharing agreement (regardless of year owed or under which
agreement owed) from any amount, other than Capitation and Professional Stop
Loss Program payments made pursuant to Exhibit H, owed by Blue Shield to Group
under this or any other agreement between Blue Shield and Group.

 

(d)                                 In the event that Group has contracted with a
provider for services at rates which are more favorable than the rates obtained
by Blue Shield and a Shared Savings Service is provided by such provider to a
Member hereunder, Group shall make best efforts to cooperate with Blue Shield
to obtain such more favorable rate for the provision of such Shared Savings
Service to such Member.

 

(e)                                  In the event Group wishes to dispute Blue
Shield determinations regarding the Shared Savings Program settlements, it
shall notify Blue Shield in writing within sixty (60) days following such
settlement determination, and if such dispute is not resolved by the parties,
Group may request arbitration as set forth in Article XI.

 

7.6                                 Blue Shield POS Benefit Program. 
This Agreement shall apply to Blue Shield POS Benefit Programs only if
so indicated on Exhibit A. attached hereto. Compensation to Group for Members
enrolled in a Blue Shield POS Benefit Program shall be as described in Exhibit
G-2 attached hereto.  Blue Shield may
offset surpluses in the POS Out-of-Network Funds settlements against any
deficits in any other risk agreement. 
Blue Shield shall not offset any deficits in the POS Out-of-Network
Funds settlements against any other amounts owed to Group by Blue Shield.

 

7.7                                 Third Party Liens.  In the event a Member seeks
and obtains a recovery from a third party or a third party’s insurer for
injuries caused to that Member, and only to the extent permitted by the
Member’s Evidence of Coverage and by California law, Group shall have the right
to assert a third party lien for and to recover from the Member the reasonable
value of Capitated Professional Services provided to the Member by Group for
the injuries caused by the third party. 
Group’s pursuit and recovery under third party liens shall be conducted
in strict accordance with the procedures set forth in the Provider Manual. Blue
Shield shall similarly have the right to assert a lien for and recover for
payments made by Blue Shield for such injuries. Group shall cooperate with Blue
Shield in identifying such third party liability claims and in providing such
information, within such time frames, as set forth in the Provider Manual.

 

22

 

7.8                                 Groups
Organized By
Geographic Regions.  In the event that Blue Shield and Group have
agreed that Group will provide services to Members in specified multiple
geographic regions, such regions shall be described in Exhibit A., and Blue
Shield shall pay Group Capitation based upon the region in which the Member
selects a Group PCP.  Shared Savings
settlements shall be determined on a region by region basis, with any amounts
owed by Blue Shield to Group for one region(s) offset by any amounts owed by
Group to Blue Shield for any other region(s).

 

7.9                                 Purpose of
Incentive Programs.  The
parties understand and agree that any payments made directly or indirectly to
the Group under the incentive provisions set forth in this Agreement, including
the Shared Savings Program (Paragraph 7.5), are not made as an inducement to
reduce or limit Medically Necessary Covered Services to any specific Member.

 

7.10                      Blue Shield Timeliness Guarantee.  Except for reasons not
attributable to Blue Shield (e.g., natural disaster), in the event that Blue
Shield fails to:

 

(i)                                     Provide to Group a Member eligibility list on
or before the 10th day of each month, Blue Shield shall, as a penalty, pay to
Group ten cents ($0.10) for each Member, as the number of Members are
determined by the list once provided. 
If the list is provided by the 10th day of the month, no penalty is
payable even if the list is incomplete or is subsequently corrected; and,

 

(ii)                                  Pay monthly Capitation to Group within the
time limits required by this Agreement, Blue Shield shall pay interest on the
unpaid Capitation until paid, at the Bank of America prime rate plus two
percent (2%) per annum.  Such interest
is not payable if Capitation is paid within such time limits, regardless of
whether such Capitation is incomplete or subsequently corrected.

 

7.11                           Encounter Data Submission Penalties. 
Based on Blue Shield’s quarterly determinations and following no less
than thirty (30) days prior notice to Group, Blue Shield may withhold a portion
of Group’s Capitation, as set forth in Exhibit C., in the event that Blue
Shield determines that a significant portion (as described in the Provider Manual)
of the monthly Encounter Data which Group is obligated to provide (Paragraph
2.12) has not been delivered to Blue Shield within the prior quarter.  If at the quarterly determination next
following such withhold, Blue Shield determines that Group has satisfactorily
delivered to Blue Shield the previously non-delivered Encounter Data, such
withheld Capitation shall be paid to Group, without interest.  In the event that Group does not deliver
such Encounter Data to Blue Shield prior to such quarterly determination, Blue
Shield shall be entitled to retain such withheld Capitation and will continue
to deduct from the Group’s Capitation and retain such deductions as described
in Exhibit C. from each quarter’s Capitation. 
If at a later date Group resumes the timely and complete submission of
encounter data as required by this Agreement, then Blue Shield will cease
deducting these penalties from Group’s Capitation beginning as of the month in
which compliance is demonstrated by Group.

 

23

 

VIII.  PROTECTION
OF MEMBERS

 

8.1                                 Non-discrimination.  Except as otherwise provided
in this Agreement, Group and Group Providers shall make Capitated Services
available to Members in the same manner, in accordance with the same standards,
and with no less availability as Group and Group Providers provide services to
their other patients.  Group and Group
Providers shall not discriminate against any Member in its provision of Covered
Services on account of race, sex, color, religion, national origin, ancestry,
age, physical or mental handicap, health status, disability, need for medical
care, sexual preference, or veteran’s status, or status as a Member of Blue
Shield.

 

8.2                                 Credentialed
Providers.  In
providing Capitated Services hereunder, and except as otherwise provided in
Paragraph 2.4, Group shall utilize only Group Providers who are credentialed
and re-credentialed in accordance with Blue Shield’s standards as set forth in
the Provider Manual.  Group and/or each
Group Provider shall provide to Blue Shield, on request, credentialing
information, in such form as reasonably required by Blue Shield.

 

8.3                                 Charges
to Members.

 

(a)                                  In no event, including but not limited to
nonpayment by Blue Shield or Group, or Blue Shield’s or Group’s insolvency or
breach of this Agreement (or breach by Group of its agreement with Group
Provider), shall Group and Group Providers bill, charge, collect a deposit
from, impose a surcharge on, seek compensation, remuneration or reimbursement
from or have any recourse against, Members or an individual responsible for
their care for Covered Services.  Nor
shall Group or a Group Provider seek payment from Members or individuals
responsible for their care, for payments for Covered Services denied by Blue
Shield or Group because such bill or claim was not timely or properly
submitted, or because the rendered services were not Medically Necessary or
Authorized.  Whenever Blue Shield
receives notice of a violation of this Paragraph 8.3, it shall take appropriate
action (including without limitation the right to reimburse the Member the
amount of any payment and offset the amount of such payment from any amounts
then or thereafter owed by Blue Shield to Group).

 

(b)                                 Group and Group Providers shall not bill or
collect from a Member any charges in connection with Non-Covered Services,
non-Authorized services, or services determined not to be Medically Necessary
unless Group, or as applicable, the Group Provider, has first obtained a
written acknowledgment from the Member that such services are either not
Covered Services, not Authorized, or not Medically Necessary, and that the
Member, or the Member’s legal representative, is financially responsible for
the cost of such services.  Such
acknowledgment shall be obtained prior to the time that such services are
provided to the Member and shall be in such form as meets the applicable
requirements set forth in the Provider Manual.

 

24

 

(c)                                  Group agrees that, in the event of Blue
Shield’s insolvency or other cessation of operations, Covered Services to
Members will continue through the period for which their premiums have been
paid, and Covered Services to Members confined in an inpatient facility on the
date of insolvency or other cessation of operations will continue until the
Member’s discharge.

 

(d)                                 The provisions of this Paragraph 8.3
shall:  (i) survive the termination of
this Agreement (and any agreement between Group and Group Provider) regardless
of the cause giving rise to termination and shall be construed to be for the
benefit of Members; and, (ii) supersede any oral or written contrary agreement
(now existing or hereafter entered into) between the Group or Group Provider
and the Member.

 

(e)                                  The provisions of this Paragraph 8.3 shall be
incorporated into any agreement between the Group and its contracted healthcare
providers.  This Paragraph 8.3 shall not
be changed without the prior approval of the appropriate government regulatory
agency.

 

8.4                                 Protection of Members.  In the event that Blue Shield
or a Member notifies Group that a Group Provider (or physician providing
coverage for such Group Provider), or another provider who provided Capitated
Professional Services to the Member is billing, suing, or otherwise attempting
to collect (“Collection”) payment from the Member or person responsible for the
Member’s care, other than Copayments, Group shall immediately take all
reasonable and appropriate actions to stop such Collection.  In the event that Group is unable to timely
stop such Collection, as determined by Blue Shield, Blue Shield may take any
steps it deems appropriate, including payment of the claim, to stop such
Collection.  In such event, Blue Shield
may deduct and offset such payment from any amount then or thereafter payable
by Blue Shield to Group.

 

8.5                                 Benefits Determination.  All final decisions regarding
coverage are reserved to Blue Shield, and Group shall refer Members who have
inquiries or disputes regarding such coverage to Blue Shield for response and resolution.  This provision, however, does not and shall
not be construed to prohibit any physician from providing any medical
treatment, or other advice which such physician believes to be in the best
interest of the patient.

 

8.6                                 Member Complaints and Grievances. 
Group shall promptly notify Blue Shield of receipt of any claims,
including professional liability claims filed or asserted by a Member against
Group or a Group Provider.  Group shall
cooperate with Blue Shield in identifying, processing, and resolving all Member
grievances and other complaints, in accordance with Blue Shield’s
complaint/grievance process and time limits set forth in the Provider Manual,
as well as in accordance with such time limits as required by state and/or
federal law.  Group shall comply with
Blue Shield’s resolution of any such complaints or grievances including
specific findings, conclusions and orders of the Department of Corporations.

 

25

 

8.7                                 Medical Necessity Assistance.  In
all cases where the Group and/or a Group Provider has made a determination
regarding the Medical Necessity of a medical service requested or provided to a
Member, Group shall, upon the request of Blue Shield, assist Blue Shield in
determining the Medical Necessity of such service and provide relevant medical
records to Blue Shield and participate in any grievance, arbitration, and/or
other proceedings in which such Medical Necessity determination is an
issue.  Moreover, Group agrees to
cooperate with and abide by the Medical Necessity determination of any external
review entity to which Blue Shield is either obligated by law to submit such
disputes or for which Blue Shield has implemented a program to submit such
disputes to external review.

 

8.8                                 Free Exchange
of Information.  No
provision of this Agreement shall be construed to prohibit, nor shall any
provision in any contract between Group and its employees or subcontractors
prohibit, the free, open and unrestricted exchange of any and all information of
any kind between health care providers and Members regarding the nature of the
Member’s medical condition, the health care treatment options and alternatives
available and their relative risks and benefits, whether or not covered or
excluded under the Member’s health plan, and the Member’s right to appeal any
adverse decision made by Group or Blue Shield regarding coverage of treatment
which has been recommended or rendered. 
Moreover, Group shall not penalize nor sanction any health care provider
in any way for engaging in such free, open and unrestricted communication with
a Member nor for advocating for a particular service on a Member’s behalf.

 

8.9                                 Insurance.

 

(a)                                  Group and Group Providers shall maintain
professional liability (malpractice) insurance and general liability insurance
coverage in the minimum amount of One Million Dollars ($1,000,000) per
occurrence and Three Million Dollars ($3,000,000) annual aggregate per
physician per year for all physicians who are partners, associates or employees
of Group and warrants that all physicians with which Group contracts will carry
professional liability coverage in the same amount.  If Group or its Group Providers or subcontracts have a claims
made malpractice insurance policy, then they agree to keep the policy in effect
for at least five (5) years past any termination of this Agreement or purchase
extended reporting coverage (tail insurance).

 

(b)                                 Each Group Provider who is not a physician
shall maintain insurance as set forth above, but with commercially reasonable
policy limits appropriate to the risk being insured.

 

(c)                                  Group and Group Providers shall maintain
Workers’ Compensation insurance covering all employees of Group or, as
applicable, of Group Provider.

 

(d)                                 Group shall notify Blue Shield and provide
evidence to Blue Shield at the time of any amendment, change or modification to
such insurance coverage and at

 

26

 

any
time on reasonable request by Blue Shield during the term of this Agreement.

 

IX.  MEDICAL
RECORDS &  CONFIDENTIALITY

 

9.1                                 Medical Records. 
Group and Group Providers shall maintain the usual and customary records
for Members in the same manner as for other patients of Group and Group
Providers.  Group will require that all
Group Physicians establish and maintain in an accurate and timely manner for
each Member who has obtained care from such physician a medical record which is
organized in a manner which contains such demographic and clinical information
as is necessary, in the opinion of the Blue Shield medical director and the
Group medical director, to provide documentation as to the medical problems and
medical services provided to the Member. 
Such record shall include a historical record of diagnostic and
therapeutic services recommended or provided by, or under the direction of, the
provider.  Such records shall be in such
a form as to allow trained health professionals, other than the provider, to
readily determine the nature and extent of the Member’s medical problem and the
services provided and permit peer review of the care provided.  Such records shall, on request, and within
reasonable time requirements, be made available without charge to Blue Shield
and its designated agents.  Without
limiting the foregoing, Group shall, without charge, transmit Member’s medical
records information to a Member’s other providers, to Government Officials, and
to Blue Shield for purposes of utilization management, quality improvement and
other Blue Shield administrative purposes. 
Upon termination of this Agreement, or the re-assignment or transfer of
Members, one copy of such records shall be provided without charge to the
Member’s new medical group upon request.

 

9.2                                 Confidentiality. 
Group and Group Providers shall comply with all applicable state and
federal laws regarding privacy and confidentiality of medical information and
records, including mental health records. 
Group and Group Providers shall develop policies and procedures to
ensure that Member medical records are not disclosed in violation of Cal.
Civ. Code §§ 56, et seq.  To the
extent Group receives, maintains or transmits medical or personal information
of Members electronically, Group shall comply with all state and federal laws
relating to the protection of such information including, but not limited to,
the Health Insurance Portability and Accountability Act (HIPAA) provisions on
security and confidentiality and any CMS regulations or directives relating to
Medicare beneficiaries.

 

9.3                                 Member Access to Records. 
Group and Group Providers shall ensure that Members have access to their
medical records in accordance with the requirements of state and federal law.

 

27

 

X.  COOPERATION
WITH AUDITS &  CERTIFICATIONS

 

10.1                           Disclosure of Records.

 

(a)                                  Group and each Group Provider shall comply
with all provisions of the Omnibus Reconciliation Act of 1980 regarding access
to books, documents, and records. 
Without limiting the foregoing, Group shall maintain such records and
provide such information to Blue Shield as well as to DMHC, CMS, any Peer
Review Organization (“PRO”) with which Blue Shield contracts as required byCMS,
the U.S.  Comptroller General, their
designees and any other governmental officials entitled to such access by law
(collectively, “Governmental Officials”) as required by law and as may be
necessary for compliance by Blue Shield with the provisions of all state and
federal laws governing Blue Shield. 
Blue Shield and Government Officials shall have access to, and copies
of, at reasonable time upon request, the medical records, books, charts, and
papers relating to the Provider’s provision of health care services to Members,
the cost of such services, and payment received by the Provider from the Member
(or from others on their behalf), and to the financial condition of the
provider.  Such records described herein
shall be maintained at least six (6) years from the end of each Agreement Year,
and, if this Agreement is applicable to Blue Shield 65 Plus, six (6) years from
the close of CMS’ fiscal year in which the contract was in effect (or for a
particular record or group of records, a longer time period when or DMHC
requests such longer record retention and Group is notified of such request by
Blue Shield), and in no event for a shorter period than as may be required by
the Knox-Keene Act and the regulations promulgated thereunder.  All records of Group/Providers shall be
maintained in accordance with the general standards applicable to such book or
record keeping and shall be maintained during any governmental audit or
investigation.

 

(b)                                 Group shall, on request, disclose to
Government Officials the method and amount of compensation or other
consideration to be received by it from Blue Shield or payable by Group to its
subcontractors.  Group shall maintain
and make available to Government Officials: 
(i) its subcontracts, and (ii) compensation/financial records relating
to such subcontracts and compensation from Blue Shield.

 

(c)                                  Upon forty-eight (48) hours notice, Group
shall make any records of its quality improvement and utilization review
activities pertaining to Members and provider credentialing files available to
Blue Shield’s quality and utilization review committee.  Such sharing of records between the two
committees shall be in accordance with, and limited to, Sections 1157 of the
California Evidence Code and 1370 of the California Health and Safety Code and
shall not be construed as a waiver of any rights or privileges conferred on
either party by those statutes.

 

28

 

(d)                                 Blue Shield, at its sole cost and expense,
and with reasonable prior notice to Group, may from time to time audit the
books and records of Group as they relate to its services, claims payments,
authorization turn-around times, reporting, and billings under this Agreement.

 

10.2                           Site Evaluations. 
Group and Group Providers shall permit Government Officials and Blue
Shield to conduct periodic site evaluations and inspections of their facilities
and records.  In the event that
Government Officials or Blue Shield find any deficiencies in such facilities or
records, Group, or Group Provider, as applicable, shall have thirty (30) days
to substantially correct such deficiencies which are identified by such Government
Officials or Blue Shield.

 

10.3                           Accreditation Surveys. 
Group and Group providers shall cooperate in the manner described in
Paragraphs 10.1 and 10.2 hereof with respect to surveys and site evaluations
relating to accreditation of Blue Shield by NCQA or any other accrediting
organization.  Further, Group agrees to
implement any changes reasonably required as a result of all such surveys.

 

10.4                           Compliance Monitoring. 
Group shall cooperate with Blue Shield in the performance of any
monitoring, studies, evaluations analyses or surveys required by Government
Officials or accrediting organizations of Group’s performance of services
hereunder.

 

XI.  RESOLUTION OF DISPUTES

 

11.1                           Provider Dispute Resolution Procedure. 
Blue Shield and Group agree to meet and confer in good faith to resolve
any disputes that arise under this Agreement, except for dispute relating to
the procedure whereby this Agreement may be terminated, which disputes shall be
governed exclusively by Paragraph 11.2 hereof. 
If such disputes remain unresolved, they may be referred to the Blue
Shield Provider Dispute Resolution Committee. 
Disputes may be submitted in writing addressed to Blue Shield Dispute
Resolution Committee, Attn: Network Manager, Provider Services, P. O. Box
629011, El Dorado Hills, CA 95762-9011. 
Disputes referred to the Blue Shield Provider Dispute Resolution
Committee shall be decided within thirty (30) days of referral.  If such disputes cannot be resolved by the
Blue Shield Provider Dispute Resolution Committee, Blue Shield and Group agree
to submit the dispute to binding arbitration pursuant to Section 11.2 of this
Agreement.  Group further agrees that
the procedures set forth in this Paragraph 11.1 may be used in the event that a
Group Provider has a dispute with Group. 
Pursuit by Group of a dispute through the processes described in this
Article XI, shall not modify nor relieve Group of any obligations to continue
to provide services to Members in accordance with and to comply with all terms
of this Agreement.

 

11.2                           Arbitration of Disputes.  If
any dispute, controversy, or misunderstanding (other than a claim of medical
malpractice) arises between the parties to this Agreement which exceeds the
jurisdiction of Small Claims Court, which was not resolved in the

 

29

 

Provider
Dispute Resolution procedure set forth in Paragraph 11.1, and which may
directly or indirectly concern or involve any term, covenant, or condition
hereof, the parties shall settle the dispute by final and binding arbitration
in San Francisco, Los Angeles, San Diego or Sacramento, California, whichever
city is closest to the Group. 
Arbitration shall be conducted under the Commercial Rules of the
American Arbitration Association.  The
arbitration decision shall be binding on both parties.  It is agreed that the arbitrator shall be
bound by applicable state and federal law and that the arbitrator shall issue
written findings of fact and conclusions of law.  The arbitrator shall have no authority to award damages or
provide a remedy which would not be available to such prevailing party in a
court of law nor shall the arbitrator have the authority to award punitive
damages.  The cost of the arbitration
shall be shared equally by Group and Plan. 
Each party shall be responsible for its own attorneys’ fees.

 

11.3                           Cooperation With Member Disputes. 
Group and Group Providers shall cooperate in the Member grievance and
appeals process as described in the Provider Manual.

 

XII.  TERM
& TERMINATION

 

12.1                           Term.  When executed by both
parties, this Agreement shall become effective as of the Effective Date, and
shall continue in effect for three (3) years thereafter, unless earlier
terminated as set forth below.  Unless
either party notifies the other party at least one hundred eighty (180) days
prior to the expiration of said initial three (3) year term, this Agreement
shall, following expiration of the initial term, continue in effect for
additional one (1) year terms until terminated as set forth below.

 

12.2                           Termination Without Cause. 
Either party may terminate this Agreement at anytime without cause by
giving to the other party at least one hundred eighty (180) calendar days
written notice of termination.  The
termination shall become effective the first day of the month following the
expiration of the notice period.

 

12.3                           Termination for Cause. 
Either party may, subject to the cure period set forth in Paragraph
12.4, terminate this Agreement for material cause after written notice as set
forth hereinafter. The following shall constitute a material cause for
termination:

 

(a)                                  By Group if: (i) Blue Shield fails to pay Group the Capitation due to Group
hereunder within twenty (20) days of such payment’s due date; or, (ii)
revocation of Blue Shield’s license necessary for the performance of this
Agreement; or, (iii) Blue Shield breaches any material term, covenant, or
condition of this Agreement.

 

(b)                                 By Blue Shield if: 
(i) the filing of bankruptcy by a parent or subsidiary or substantial
deterioration in the financial condition of a parent, affiliate or subsidiary,
or, (ii) Group fails to provide quality medical services consistent with the
standards set forth in this Agreement and in the Provider Manual; or,

 

30

 

(iii)
Group breaches any material term, covenant, or condition of this Agreement.

 

Notwithstanding
any provision of Paragraph 12.4 to the contrary, Blue Shield may immediately
terminate this Agreement in the event that Group is excluded from participation
in Medicare or Group fails to maintain all insurance required herein, or if
Blue Shield, after consultation with Group, determines in good faith that
continuation of this Agreement may reasonably be expected to jeopardize the
health, safety, or welfare of Members, or if Blue Shield reasonably determines,
after consulting with Group, that Group is likely to be financially unable to
provide and/or pay for, in a competent and timely manner, Capitated
Professional Services.

 

12.4                           Notice and Cure Period.  A
party seeking to terminate this Agreement for material breach shall notify the
other party in writing of the nature of the breach and the other party shall
have thirty (30) days from the receipt of such notice to cure or otherwise
eliminate such cause.  If the other party
does not remedy the breach, to the reasonable satisfaction of the non-breaching
party, this Agreement shall terminate at the end of the thirty (30) day period.

 

12.5                           Termination Not an Exclusive Remedy.  The
termination of this Agreement by either party pursuant to this Article XII is
not an exclusive remedy and such terminating party retains whatever rights in
law or equity as may be necessary to enforce its rights under this Agreement.

 

12.6                           Effect of Termination.  As
of the date of termination, this Agreement shall be considered of no further
force or effect whatsoever, and each of the parties shall be relieved and
discharged herefrom, except that:

 

(a)                                  Termination shall not affect any rights or
obligations hereunder which have previously accrued, or shall hereafter arise
with respect to any occurrence prior to termination, and such rights and
obligations shall continue to be governed by the terms of this Agreement.

 

(b)                                 Group shall, at Blue Shield’s option,
continue rendering Capitated Professional Services after the termination of
this Agreement to Members assigned to Group at the capitation rates in effect
immediately prior to the date of termination, for the duration of the contracts
in effect with Blue Shield through which Members are enrolled with Blue Shield,
or until such time as Blue Shield has arranged for an alternative source of
services for each such Member from other contracting providers.

 

(c)                                  Group shall, in the event of Blue Shield’s
insolvency, continue rendering Capitated Professional Services to any Member
who is an inpatient of a hospital until such Member’s discharge or transfer to
another appropriate facility.

 

31

 

(d)                                 The following paragraphs of this Agreement
shall survive the termination of this Agreement, whether such termination is
the result of rescission or otherwise: Paragraphs 2.9(b), 3.1, 5.1, 8.3, 8.4,
8.6, 8.7, 8.8, 10.1, 11.1, 11.2, 14.9, and 14.10.

 

XIII.  COMPLIANCE
WITH LEGAL REQUIREMENTS

 

13.1                           Consistency with State Law. This Agreement is subject to the
requirements of Chapter 2.2 of Division 2 of the California Health &  Safety Code (the Knox-Keene Act) and of
Subchapter 5.5 of Chapter 3 of Title 10 of the California Administrative
Code.  Any provision required to be in this
Agreement by either of the above Codes shall bind Blue Shield and Group,
whether or not provided in this Agreement. 
Group shall require that Group Providers similarly comply with all
applicable provisions of the Act and Rules.

 

13.2                           Consistency with Federal Law.  If
this Agreement applies to Blue Shield 65 Plus, Group shall comply and Group
shall require that its Group Providers comply with the statutes and regulations
and CMS instructions which govern Blue Shield’s Agreement with CMS.  Moreover, Group and Group Providers shall
comply with the additional obligations set forth in Exhibit H-l hereto.  Group also agrees that, to the extent ERISA
statutes and regulations apply to the claims payment and Member complaint
functions performed by Group, Group and Group Providers shall comply with all
such requirements.

 

13.3                           Coordination of Benefits. 
Group agrees that coordination of benefits, benefit determinations under
the Medicare Secondary Payor rules, and Workers’ Compensation recoveries shall
be conducted by Group in accordance with the procedures set forth in the
Provider Manual.

 

13.4                           Timely Payment.  In
making payments to Group Providers and other providers for Capitated
Professional Services as set forth in Article III, hereof, Group shall comply
and shall cause all subcontractors to whom claims payment obligations are
delegated to comply with the timeliness requirements set forth in applicable
state and federal law, including, but not limited to, Section 1371 of the
Knox-Keene Act and any applicable CMS rules and regulations.

 

13.5                           Disclosure of Provider Profiling. 
Group shall, upon request from Blue Shield and as further described in
the Provider Manual, provide Blue Shield with information regarding any
“economic profiling” of Group Providers by Group in order to permit Blue Shield
to comply with the provisions of Section 1367.02 of the Knox- Keene Act.  Further, to the extent that group utilizes
“economic profiling” as defined in Section 1367.02, Group shall provide copies
of economic profiling information to Group Providers in accordance with the
requirements of Section 1367.02.

 

32

 

13.6                           Provider Terminations.  In
the event that a subcontract with a Group Provider is denied, suspended or
terminated, Group shall provide the provider with written notice of the reason
for the action as required by state and federal law, including any standards
and profiling data Group used to evaluate the provider, the number and mix of
similar health care providers that Group needs (if applicable), and notice of
the provider’s right to appeal the action, including notice of the process and
timing to request a hearing.  In the
event Group terminates a contract with a Group Provider for deficiencies in the
quality of care provider, Group shall give notice of the action to the
appropriate licensing and disciplinary bodies.

 

13.7                           Financial Solvency Reporting.  The
Group shall, as further described in the Provider Manual, submit Quarterly and
Annual reports to the Department of Managed Health Care in compliance with the
legal requirements of Subchapter 5.5 of Chapter 3 of Title 28, California Code
of Regulations §1300.75.4.2.

 

13.8                           Blue Shield Reporting Requirements  Blue
Shield shall submit Quarterly and Annual reports to the Department of Managed
Health Care in compliance with the legal requirements of Subchapter 5.5 of
Chapter 3 of Title 28, California Code of Regulations § 1300.75.4.3.

 

XIV.  GENERAL PROVISIONS

 

14.1                           Waiver of Breach.  The
waiver of any breach of this Agreement by either party shall not constitute a
continuing waiver of any subsequent breach of either the same or any other
provisions of this Agreement.

 

14.2                           Amendments.  Except as provided in this
Paragraph 14.2 and in Paragraphs 1.5 and 5.2, this Agreement may be amended
only by mutual, written consent of Blue Shield and Group’s duly authorized
representatives.  Notwithstanding the
foregoing, or if Blue Shield’s legal counsel determines in good faith that this
Agreement must be modified to be in compliance with applicable federal or state
law or to meet the requirements of accreditation organizations which accredit
Blue Shield and its providers, Blue Shield may amend this Agreement by
delivering to Group (the “Notice Date”) a copy of the modifications  (the 
“Legally-Required Modifications”) along with the reasons therefore, and
such modification(s) shall be deemed accepted by Group and an amendment to this
Agreement if Group does not, within thirty (30) days following said Notice
Date, deliver to Blue Shield its written objection of such Legally-Required
Modification(s).  In the event that
Group timely objects to such Legally-Required Amendment, such amendment shall
nevertheless become effective as of the date set forth in said amendment, and
Group, in the event Group and Blue Shield cannot resolve Group’s objection, may
terminate this Agreement on ninety (90) days prior written notice to Blue
Shield.

 

14.3                           Entire Agreement. 
This Agreement, all attachments and Exhibits referenced in this
Agreement and attached hereto, and the Provider Manual, as amended from time to
time, are incorporated herein by reference, and constitute the entire
understanding between the parties relating to the subject matter hereof.  This Agreement does not

 

33

 

supersede
or modify any agreement between the parties pertaining to Blue Shield’s PPO
Benefit Programs, including without limitation, any Physician Member
Application and Agreement between the parties or between Blue Shield and Group
physicians.

 

14.4                           Independent Contractors.  In
the performance of each party’s work, duties, and obligations pursuant to this
Agreement, each of the parties shall at all times be acting and performing as
an independent contractor, and nothing in the Agreement shall be construed or
deemed to create a relationship of employer and employee or partner or joint
venturer or principal and agent.  Each
party agrees to indemnify, defend and hold harmless the other party from any
claims, causes of action or costs, including reasonable attorneys’ fees,
arising out of the indemnifying parties alleged or actual negligence or
otherwise improper performance of its obligations hereunder.

 

14.5                           Notices.  Any notices or other
communication made or contemplated by this Agreement to be in writing shall be
deemed to have been received by the party to whom it is addressed three (3)
days after it is deposited in the United States mail, certified postage
prepaid, return receipt requested, or the date of delivery by Federal Express or
similar commercial courier service, and addressed as set forth in Exhibit A.,
or to such other address as either party from time to time informs the other in
writing.  Further, notice may be given
during normal business hours by facsimile transmission to the number set forth
in Exhibit A. which shall be deemed received upon facsimile transmission
confirmation, or by personal delivery to the address set forth in Exhibit A.
which shall be deemed received upon receipt of a signature from the person or
office at the designated address.

 

14.6                           Third Party Beneficiaries. 
Except as set forth in Paragraph 2.10, neither Members nor any other
third parties are intended by the parties hereto to be third party
beneficiaries under this Agreement, and no action to enforce the terms of this
Agreement may be brought against either party by any person who is not a party
hereto.

 

14.7                           Assignment Subcontracting, and Addition of
PCPs.

 

(a)                                  Neither Blue Shield nor Group shall assign,
transfer, or subcontract its rights, duties, or obligations under this
Agreement without the prior written consent of the other party.

 

(b)                                 For purposes of providing services to Members
hereunder, Group may not add as PCPs any physician whose principal medical
office is located outside the postal zip codes set forth as PCP Zip Codes in
Exhibit A., without Blue Shield’s prior written consent, which consent may be
granted or withheld by Blue Shield in its sole discretion.

 

14.8                           Interpretation of Agreement.  In
the event of any ambiguity in this Agreement, this Agreement shall be
interpreted according to its fair intent and not for or against any one party
on the basis of which party drafted the Agreement.  This Agreement shall be governed in all respects, whether as to
validity, construction, capacity, performance or

 

34

 

otherwise,
by the laws of the State of California and such federal laws as are applicable
to Blue Shield.  If for any reason any
provision of this Agreement is held invalid, the remaining provisions shall
remain in full force and effect.  The
captions herein are for convenience only and shall not affect the meaning or
interpretation of the Agreement.

 

14.9                           Confidentiality/Trade Secrets.  The
compensation terms of this Agreement and all terms relating to compensation
shall be confidential.  Group shall not
disclose such terms (other than to Government Officials) except with the prior
written consent of Blue Shield. 
However, nothing herein shall prohibit Group or Group Providers from
disclosing to Members and others the method by which they are compensated
(e.g., capitation, fee-for-service, etc.); it is the precise compensation
amounts for which confidential treatment is required by this provision.

 

14.10                     Non-Solicitation. 
During the term of this Agreement, and for one (1) year thereafter,
neither Group nor Group Providers shall solicit, induce, or encourage any
Member to disenroll from Blue Shield or select another health care service plan
for healthcare services. 
Notwithstanding the foregoing, Group and Group Providers shall be
entitled to freely communicate with Members regarding any aspect of their
health status or treatment.

 

14.11                     Association Disclosure. 
Group hereby expressly acknowledges its understanding that this
Agreement constitutes a contract between Group and Blue Shield, that Blue
Shield is an independent corporation operating under a license from the Blue
Cross and Blue Shield Association, an association of independent Blue Cross and
Blue Shield Plans (“the Association”) permitting Blue Shield to use the Blue
Shield Service Mark in the State of California, and that Blue Shield is not
contracting as the agent of the Association. 
Group further acknowledges and agrees that it has not entered into this
Agreement based upon representations by any person other than Blue Shield and
that no person, entity, or organization other than Blue Shield shall be held
accountable or liable to Group for any of Blue Shield’s obligations to Group
created under this Agreement.  This
paragraph shall not create any additional obligations whatsoever on the part of
Blue Shield other than those obligations created under other provisions of this
Agreement.

 

IN
WITNESS WHEREOF, the parties have caused this Agreement to be executed by their
authorized representatives.

 

35

 

	
  BLUE SHIELD OF CALIFORNIA

  	
   

  	
  NORTHWEST
  ORANGE COUNTY

  MEDICAL GROUP.

  
	
   

  	
   

  	
   

  
	
  Signature:

  	
  /s/ Lisa Farnan

  	
   

  	
   

  	
  Signature:

  	
  /s/ Pratibha Patel

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Print
  Name:

  	
  Lisa Farnan

  	
   

  	
   

  	
  Print
  Name:

  	
  PRATIBHA PATEL, MD

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Title:

  	
  VP,
  Provider Relations

  	
   

  	
   

  	
  Title:

  	
  PRESIDENT

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Date:

  	
  3-21-03

  	
   

  	
   

  	
  Date:

  	
  3/14/03

  	
   

  
												

 

	
   

  	
   

  	
  NORTHWEST
  ORANGE COUNTY

  MEDICAL GROUP.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  Signature:

  	
  /s/ James P. Aronick

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  Title:

  	
  CEO

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  Date:

  	
  3/14/03

  	
   

  
											

 

 

	
   

  	
  /s/
  James P. Aronick

  	
   

  
	
   

  	
  CEO

  	
   

  
	
   

  	
  3/14/03

  	
   

  

 

 

GROUP’S TAX ID #:  330112414

 

	
  GROUP IS
  A:

  	
   ý

  	
  IPA

  	
  o

  	
  Ltd. Knox-Keene Licensee

  
	
   

  	
  o

  	
  Integrated Medical Group

  	
  o

  	
  Other (Specify):

  
	
   

  	
  o

  	
  Foundation

  	
   

  

 

IN RESPECT TO THE PROFESSIONAL STOP LOSS COVERAGE (AND
APPLICABLE CHARGES BY PLAN), THE GROUP ELECTS AS FOLLOWS:

 

The Professional Stop Loss
Coverage set forth in Schedule H:

 

	
   

  	
  o  Will Participate

  	
   

  	
  ý  Will not Participate

  

 

36

 

EXHIBIT A

 

HMO IPA/Medical Group Agreement

 

GROUP INFORMATION & BENEFIT PROGRAMS

 

NORTHWEST ORANGE COUNTY MEDICAL GROUP

 

Effective Date:   FEBRUARY
1, 2003

 

1.                                       Address for Notice:

 

	
  If to Blue Shield

  	
   

  	
  If to
  Group

  
	
  Blue Shield of California

  	
   

  	
  NorthWest Orange County
  Medical Group

  
	
  6701 Center Drive West

  	
   

  	
  2600 Redondo Avenue

  
	
  Los Angeles, CA 90045

  	
   

  	
  Long Beach, CA 90806

  
	
  Attn:  Regional
  Executive

  	
   

  	
  Attn: Chief Executive
  Officer

  
	
  Fax No.: 310-670-2329

  	
   

  	
  Fax No: (562) 988-7400

  

 

2.                                       (a)                                  Group Regions:  NorthWest Orange County Medical
Group – La Palma

   NorthWest
Orange County Medical Group – Anaheim

 

(b)                                 Zip Codes See Exhibit A-1, Exhibit A-1.1

 

3.                                       Benefit Programs: This Agreement is applicable to the
following Benefit Programs:

 

(1)                                  Commercial Group, Point of Service and
Individual

 

Plans                                                                   ý  Yes       o No

 

(2)                                  Healthy Families                         o  Yes       ý No

 

(3)                                  Blue Shield 65 Plus (Medicare+
Choice)       o  Yes       ý No

 

(4)                                  Other (Describe)

 

*                                         For Blue Shield 65+, Members will be
permitted to select Group and its Primary Care Physicians if they reside anywhere
within the Medicare contract service area in which Group is located, in
accordance with Medicare guidelines.

 

***

 

37

 

EXHIBIT A-1

 

NORTHWEST ORANGE COUNTY
MEDICAL GROUP - LA PALMA

ZIP CODES

 

Within 30 miles from 90623

 

	
  City

  	
   

  	
  County

  	
   

  	
  State

  	
   

  	
  AVGDIST_

  A1

  	
   

  	
  ZIP

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.3

  	
   

  	
  91803

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.9

  	
   

  	
  91841

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.9

  	
   

  	
  91899

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21

  	
   

  	
  91802

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21

  	
   

  	
  91804

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21

  	
   

  	
  91896

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.1

  	
   

  	
  91800

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.2

  	
   

  	
  91801

  	
   

  
	
  ALISO VIEJO

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  21.3

  	
   

  	
  92698

  	
   

  
	
  ALTADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.1

  	
   

  	
  91002

  	
   

  
	
  ALTADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.1

  	
   

  	
  91003

  	
   

  
	
  ALTADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29

  	
   

  	
  91001

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  3.3

  	
   

  	
  92801

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.8

  	
   

  	
  92809

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.8

  	
   

  	
  92803

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.8

  	
   

  	
  92804

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.8

  	
   

  	
  92850

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6.1

  	
   

  	
  92814

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6.9

  	
   

  	
  92815

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.5

  	
   

  	
  92800

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.7

  	
   

  	
  92805

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.8

  	
   

  	
  92812

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9

  	
   

  	
  92816

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.1

  	
   

  	
  92802

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.9

  	
   

  	
  92806

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.6

  	
   

  	
  92825

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.3

  	
   

  	
  92817

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.3

  	
   

  	
  92899

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.5

  	
   

  	
  92807

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  16.3

  	
   

  	
  92808

  	
   

  
	
  ARCADIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.1

  	
   

  	
  91077

  	
   

  
	
  ARCADIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.4

  	
   

  	
  91007

  	
   

  
	
  ARCADIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.6

  	
   

  	
  91066

  	
   

  
	
  ARCADIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.4

  	
   

  	
  91006

  	
   

  
	
  ARTESIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  3.2

  	
   

  	
  90701

  	
   

  
	
  ARTESIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  4.2

  	
   

  	
  90702

  	
   

  
	
  ATWOOD

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13.1

  	
   

  	
  92811

  	
   

  
	
  AZUSA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.7

  	
   

  	
  91702

  	
   

  
	
  BALDWIN PARK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18

  	
   

  	
  91706

  	
   

  

 

***
Confidential Treatment requested.

 

38

 

	
  BALDWIN PARK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.7

  	
   

  	
  91797

  	
   

  
	
  BELL

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.8

  	
   

  	
  90201

  	
   

  
	
  BELL GARDENS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17

  	
   

  	
  90202

  	
   

  
	
  BELLFLOWER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  7.1

  	
   

  	
  90706

  	
   

  
	
  BELLFLOWER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  7.5

  	
   

  	
  90707

  	
   

  
	
  BREA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12

  	
   

  	
  92821

  	
   

  
	
  BREA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.6

  	
   

  	
  92622

  	
   

  
	
  BREA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.6

  	
   

  	
  92822

  	
   

  
	
  BREA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13.2

  	
   

  	
  92621

  	
   

  
	
  BREA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  17.1

  	
   

  	
  92823

  	
   

  
	
  BUENA PARK

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  1.8

  	
   

  	
  90622

  	
   

  
	
  BUENA PARK

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  1.9

  	
   

  	
  90620

  	
   

  
	
  BUENA PARK

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  3.7

  	
   

  	
  90624

  	
   

  
	
  BUENA PARK

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.1

  	
   

  	
  90621

  	
   

  
	
  CARSON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.7

  	
   

  	
  90747

  	
   

  
	
  CARSON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.7

  	
   

  	
  90749

  	
   

  
	
  CARSON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.7

  	
   

  	
  90746

  	
   

  
	
  CARSON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.3

  	
   

  	
  90745

  	
   

  
	
  CERRITOS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  2.3

  	
   

  	
  90703

  	
   

  
	
  CHINO

  	
   

  	
  SAN BERNARDINO

  	
   

  	
  CA

  	
   

  	
  29.1

  	
   

  	
  91708

  	
   

  
	
  CHINO

  	
   

  	
  SAN
  BERNARDINO

  	
   

  	
  CA

  	
   

  	
  29.7

  	
   

  	
  91710

  	
   

  
	
  CHINO HILLS

  	
   

  	
  SAN
  BERNARDINO

  	
   

  	
  CA

  	
   

  	
  21.3

  	
   

  	
  91709

  	
   

  
	
  CITY OF INDUSTRY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.5

  	
   

  	
  91715

  	
   

  
	
  CITY OF INDUSTRY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.6

  	
   

  	
  91716

  	
   

  
	
  COMPTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.2

  	
   

  	
  90220

  	
   

  
	
  COMPTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13

  	
   

  	
  90224

  	
   

  
	
  COMPTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.1

  	
   

  	
  90221

  	
   

  
	
  COMPTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.8

  	
   

  	
  90223

  	
   

  
	
  COMPTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.2

  	
   

  	
  90222

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  23.4

  	
   

  	
  92882

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  26

  	
   

  	
  91720

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  28.1

  	
   

  	
  92878

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  28.1

  	
   

  	
  92880

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  28.3

  	
   

  	
  91718

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  28.3

  	
   

  	
  92881

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  28.7

  	
   

  	
  92877

  	
   

  
	
  CORONA DEL MAR

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  25

  	
   

  	
  92625

  	
   

  
	
  COSTA MESA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  17.1

  	
   

  	
  92628

  	
   

  
	
  COSTA MESA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  18.2

  	
   

  	
  92626

  	
   

  
	
  COSTA MESA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  18.7

  	
   

  	
  92627

  	
   

  
	
  COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22

  	
   

  	
  91722

  	
   

  
	
  COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23

  	
   

  	
  91723

  	
   

  
	
  COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.7

  	
   

  	
  91724

  	
   

  
	
  CULVER CITY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.2

  	
   

  	
  90233

  	
   

  
	
  CULVER CITY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.9

  	
   

  	
  90230

  	
   

  
	
  CULVER CITY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.3

  	
   

  	
  90231

  	
   

  
	
  CULVER CITY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.2

  	
   

  	
  90232

  	
   

  

 

39

 

	
  CYPRESS

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  3.1

  	
   

  	
  90630

  	
   

  
	
  DIAMOND BAR

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19

  	
   

  	
  91765

  	
   

  
	
  DOWNEY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.5

  	
   

  	
  90241

  	
   

  
	
  DOWNEY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  10.1

  	
   

  	
  90239

  	
   

  
	
  DOWNEY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12

  	
   

  	
  90240

  	
   

  
	
  DOWNEY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.4

  	
   

  	
  90242

  	
   

  
	
  DUARTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.1

  	
   

  	
  91010

  	
   

  
	
  DUARTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23

  	
   

  	
  91009

  	
   

  
	
  EAST IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  24.9

  	
   

  	
  92650

  	
   

  
	
  EL MONTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.9

  	
   

  	
  91732

  	
   

  
	
  EL MONTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.4

  	
   

  	
  91731

  	
   

  
	
  EL MONTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.8

  	
   

  	
  91734

  	
   

  
	
  EL MONTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.2

  	
   

  	
  91735

  	
   

  
	
  EL SEGUNDO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.5

  	
   

  	
  90245

  	
   

  
	
  FOOTHILL RANCH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  27

  	
   

  	
  92610

  	
   

  
	
  FOUNTAIN VALLEY

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13.3

  	
   

  	
  92708

  	
   

  
	
  FOUNTAIN VALLEY

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.3

  	
   

  	
  92728

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.6

  	
   

  	
  92833

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.6

  	
   

  	
  92837

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6.3

  	
   

  	
  92633

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.5

  	
   

  	
  92632

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.8

  	
   

  	
  92832

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8

  	
   

  	
  92836

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8.9

  	
   

  	
  92838

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.3

  	
   

  	
  92634

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.3

  	
   

  	
  92834

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.2

  	
   

  	
  92631

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.6

  	
   

  	
  92635

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.9

  	
   

  	
  92831

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.4

  	
   

  	
  92835

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.1

  	
   

  	
  92846

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.8

  	
   

  	
  92645

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.7

  	
   

  	
  92845

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.1

  	
   

  	
  92641

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.9

  	
   

  	
  92841

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8.8

  	
   

  	
  92840

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9

  	
   

  	
  92644

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.1

  	
   

  	
  92642

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.1

  	
   

  	
  92842

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.3

  	
   

  	
  92844

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.7

  	
   

  	
  92640

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  1

  	
   

  	
  92643

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.3

  	
   

  	
  92843

  	
   

  
	
  GARDENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.4

  	
   

  	
  90248

  	
   

  
	
  GARDENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.4

  	
   

  	
  90247

  	
   

  
	
  GARDENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.6

  	
   

  	
  90249

  	
   

  
	
  GLENDALE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29

  	
   

  	
  91205

  	
   

  

 

40

 

	
  GLENDALE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.1

  	
   

  	
  91226

  	
   

  
	
  GLENDALE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.2

  	
   

  	
  91225

  	
   

  
	
  GLENDALE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.3

  	
   

  	
  91204

  	
   

  
	
  GLENDALE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.7

  	
   

  	
  91200

  	
   

  
	
  GLENDALE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.7

  	
   

  	
  91206

  	
   

  
	
  GLENDALE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.9

  	
   

  	
  91209

  	
   

  
	
  GLENDALE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  30

  	
   

  	
  91210

  	
   

  
	
  GLENDORA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.6

  	
   

  	
  91740

  	
   

  
	
  GLENDORA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.2

  	
   

  	
  91741

  	
   

  
	
  HACIENDA HEIGHTS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.6

  	
   

  	
  91745

  	
   

  
	
  HARBOR CITY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.1

  	
   

  	
  90710

  	
   

  
	
  HAWAIIAN GARDENS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  2.9

  	
   

  	
  90716

  	
   

  
	
  HAWTHORNE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.9

  	
   

  	
  90250

  	
   

  
	
  HAWTHORNE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.3

  	
   

  	
  90251

  	
   

  
	
  HERMOSA BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.2

  	
   

  	
  90254

  	
   

  
	
  HUNTINGTON BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.4

  	
   

  	
  92649

  	
   

  
	
  HUNTINGTON BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.5

  	
   

  	
  92605

  	
   

  
	
  HUNTINGTON BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.3

  	
   

  	
  92647

  	
   

  
	
  HUNTINGTON BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.1

  	
   

  	
  92648

  	
   

  
	
  HUNTINGTON BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  15.4

  	
   

  	
  92646

  	
   

  
	
  HUNTINGTON BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  15.9

  	
   

  	
  92615

  	
   

  
	
  HUNTINGTON PARK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.3

  	
   

  	
  90255

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21

  	
   

  	
  90310

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.5

  	
   

  	
  90303

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.2

  	
   

  	
  90305

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.3

  	
   

  	
  90304

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24

  	
   

  	
  90306

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24

  	
   

  	
  90307

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24

  	
   

  	
  90308

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24

  	
   

  	
  90313

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.2

  	
   

  	
  90300

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.4

  	
   

  	
  90302

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.5

  	
   

  	
  90301

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.1

  	
   

  	
  90309

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.3

  	
   

  	
  90398

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.6

  	
   

  	
  90311

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.6

  	
   

  	
  90312

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.6

  	
   

  	
  90397

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  20.8

  	
   

  	
  92623

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  21.3

  	
   

  	
  92606

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  22.2

  	
   

  	
  92714

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  22.3

  	
   

  	
  92612

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  22.5

  	
   

  	
  92697

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  22.7

  	
   

  	
  92720

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  22.8

  	
   

  	
  92602

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  22.8

  	
   

  	
  92616

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  22.8

  	
   

  	
  92717

  	
   

  

 

41

 

	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  23.7

  	
   

  	
  92604

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  23.8

  	
   

  	
  92614

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  23.8

  	
   

  	
  92715

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  24

  	
   

  	
  92620

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  25

  	
   

  	
  92619

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  25

  	
   

  	
  92713

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  25

  	
   

  	
  92716

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  25

  	
   

  	
  92730

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  25.8

  	
   

  	
  92618

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  26.1

  	
   

  	
  92709

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  27.7

  	
   

  	
  92603

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  27.7

  	
   

  	
  92718

  	
   

  
	
  LA CANADA FLINTRIDGE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.2

  	
   

  	
  91011

  	
   

  
	
  LA HABRA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.1

  	
   

  	
  90632

  	
   

  
	
  LA HABRA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.4

  	
   

  	
  90631

  	
   

  
	
  LA HABRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  11.5

  	
   

  	
  90633

  	
   

  
	
  LA MIRADA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  5.2

  	
   

  	
  90637

  	
   

  
	
  LA MIRADA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  5.3

  	
   

  	
  90639

  	
   

  
	
  LA MIRADA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  5.9

  	
   

  	
  90638

  	
   

  
	
  LA PALMA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  0.4

  	
   

  	
  90623

  	
   

  
	
  LA PUENTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.9

  	
   

  	
  91749

  	
   

  
	
  LA PUENTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.6

  	
   

  	
  91714

  	
   

  
	
  LA PUENTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.7

  	
   

  	
  91746

  	
   

  
	
  LA PUENTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17

  	
   

  	
  91747

  	
   

  
	
  LA PUENTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.2

  	
   

  	
  91744

  	
   

  
	
  LAGUNA HILLS

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  29.1

  	
   

  	
  92653

  	
   

  
	
  LAKEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  1.6

  	
   

  	
  90715

  	
   

  
	
  LAKEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  5.1

  	
   

  	
  90713

  	
   

  
	
  LAKEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  6.1

  	
   

  	
  90711

  	
   

  
	
  LAKEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  6.1

  	
   

  	
  90714

  	
   

  
	
  LAKEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  6.5

  	
   

  	
  90712

  	
   

  
	
  LAWN DALE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.7

  	
   

  	
  90260

  	
   

  
	
  LAWN DALE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.2

  	
   

  	
  90261

  	
   

  
	
  LOMITA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.7

  	
   

  	
  90717

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  7.2

  	
   

  	
  90846

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  8.6

  	
   

  	
  90840

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  8.9

  	
   

  	
  90807

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  8.9

  	
   

  	
  90808

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  8.9

  	
   

  	
  90815

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.3

  	
   

  	
  90842

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.5

  	
   

  	
  90809

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.5

  	
   

  	
  90847

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.5

  	
   

  	
  90848

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.5

  	
   

  	
  90888

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.9

  	
   

  	
  90803

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.9

  	
   

  	
  90805

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  10.3

  	
   

  	
  90804

  	
   

  

 

42

 

	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  10.4

  	
   

  	
  90755

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  10.7

  	
   

  	
  90806

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  10.9

  	
   

  	
  90853

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  11.1

  	
   

  	
  90814

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.1

  	
   

  	
  90810

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.2

  	
   

  	
  90844

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.3

  	
   

  	
  90801

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.3

  	
   

  	
  90845

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.4

  	
   

  	
  90800

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.8

  	
   

  	
  90813

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14

  	
   

  	
  90831

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14

  	
   

  	
  90833

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14

  	
   

  	
  90834

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14

  	
   

  	
  90835

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14

  	
   

  	
  90899

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.1

  	
   

  	
  90832

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.7

  	
   

  	
  90802

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.3

  	
   

  	
  90822

  	
   

  
	
  LOS ALAMITOS

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.4

  	
   

  	
  90721

  	
   

  
	
  LOS ALAMITOS

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6.2

  	
   

  	
  90720

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.5

  	
   

  	
  90040

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.4

  	
   

  	
  90091

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.6

  	
   

  	
  90101

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.6

  	
   

  	
  90103

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.7

  	
   

  	
  90059

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.1

  	
   

  	
  90002

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.6

  	
   

  	
  90061

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.3

  	
   

  	
  90022

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.5

  	
   

  	
  90023

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.9

  	
   

  	
  90044

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.5

  	
   

  	
  90003

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19,5

  	
   

  	
  90058

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.5

  	
   

  	
  90097

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.7

  	
   

  	
  90102

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20

  	
   

  	
  90185

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.1

  	
   

  	
  90052

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.1

  	
   

  	
  90174

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.2

  	
   

  	
  90001

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.2

  	
   

  	
  90047

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.4

  	
   

  	
  90063

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.9

  	
   

  	
  90033

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.2

  	
   

  	
  90021

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.5

  	
   

  	
  90011

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.6

  	
   

  	
  90032

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.6

  	
   

  	
  90082

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.7

  	
   

  	
  90037

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.8

  	
   

  	
  90013

  	
   

  

 

43

 

	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.3

  	
   

  	
  90031

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.5

  	
   

  	
  90014

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.8

  	
   

  	
  90053

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.8

  	
   

  	
  90079

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.9

  	
   

  	
  90062

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.1

  	
   

  	
  90030

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.1

  	
   

  	
  90051

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.1

  	
   

  	
  90054

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.1

  	
   

  	
  90060

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.1

  	
   

  	
  90086

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.1

  	
   

  	
  90087

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.1

  	
   

  	
  90089

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.2

  	
   

  	
  90007

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.2

  	
   

  	
  90055

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.2

  	
   

  	
  90099

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.3

  	
   

  	
  90043

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.3

  	
   

  	
  90081

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.3

  	
   

  	
  90084

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.4

  	
   

  	
  90088

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.4

  	
   

  	
  90189

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.5

  	
   

  	
  90012

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.5

  	
   

  	
  90071

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.5

  	
   

  	
  90074

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.5

  	
   

  	
  90096

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.6

  	
   

  	
  90015

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.6

  	
   

  	
  90017

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.8

  	
   

  	
  90009

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.8

  	
   

  	
  90080

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.4

  	
   

  	
  90042

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.9

  	
   

  	
  90057

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26

  	
   

  	
  90006

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26

  	
   

  	
  90083

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.1

  	
   

  	
  90045

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.2

  	
   

  	
  90008

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.2

  	
   

  	
  90050

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.5

  	
   

  	
  90018

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.6

  	
   

  	
  90041

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.7

  	
   

  	
  90026

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.1

  	
   

  	
  90056

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.2

  	
   

  	
  90016

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.3

  	
   

  	
  90010

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.4

  	
   

  	
  90075

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.4

  	
   

  	
  90076

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.8

  	
   

  	
  90005

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.8

  	
   

  	
  90039

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.9

  	
   

  	
  90019

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.9

  	
   

  	
  90020

  	
   

  

 

44

 

	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28

  	
   

  	
  90065

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28

  	
   

  	
  90070

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.5

  	
   

  	
  90004

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.7

  	
   

  	
  90029

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.7

  	
   

  	
  90094

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.1

  	
   

  	
  90027

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.2

  	
   

  	
  90034

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.5

  	
   

  	
  90036

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.5

  	
   

  	
  90066

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.5

  	
   

  	
  90072

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.9

  	
   

  	
  90038

  	
   

  
	
  LYNWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.2

  	
   

  	
  90262

  	
   

  
	
  MANHATTAN BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.7

  	
   

  	
  90267

  	
   

  
	
  MANHATTAN BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.3

  	
   

  	
  90266

  	
   

  
	
  MARINA DEL REY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.6

  	
   

  	
  90295

  	
   

  
	
  MARINA DEL REY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.8

  	
   

  	
  90292

  	
   

  
	
  MAYWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.4

  	
   

  	
  90270

  	
   

  
	
  MIDWAY CITY

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.2

  	
   

  	
  92655

  	
   

  
	
  MONROVIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.1

  	
   

  	
  91016

  	
   

  
	
  MONROVIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.4

  	
   

  	
  91017

  	
   

  
	
  MONTEBELLO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.1

  	
   

  	
  90640

  	
   

  
	
  MONTEREY PARK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.7

  	
   

  	
  91755

  	
   

  
	
  MONTEREY PARK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.5

  	
   

  	
  91756

  	
   

  
	
  MONTEREY PARK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.7

  	
   

  	
  91754

  	
   

  
	
  MOUNT WILSON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.5

  	
   

  	
  91023

  	
   

  
	
  NEWPORT BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  19

  	
   

  	
  92663

  	
   

  
	
  NEWPORT BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  20.3

  	
   

  	
  92659

  	
   

  
	
  NEWPORT BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  21.9

  	
   

  	
  92658

  	
   

  
	
  NEWPORT BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  22.2

  	
   

  	
  92660

  	
   

  
	
  NEWPORT BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  23.9

  	
   

  	
  92661

  	
   

  
	
  NEWPORT BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  23.9

  	
   

  	
  92662

  	
   

  
	
  NEWPORT COAST

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  26.1

  	
   

  	
  92657

  	
   

  
	
  NORCO

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  29.9

  	
   

  	
  91760

  	
   

  
	
  NORWALK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  6.4

  	
   

  	
  90651

  	
   

  
	
  NORWALK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  6.8

  	
   

  	
  90650

  	
   

  
	
  NORWALK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  7.1

  	
   

  	
  90652

  	
   

  
	
  NORWALK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  7.1

  	
   

  	
  90659

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.4

  	
   

  	
  92857

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.5

  	
   

  	
  92664

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.6

  	
   

  	
  92865

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.7

  	
   

  	
  92665

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.1

  	
   

  	
  92868

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.6

  	
   

  	
  92668

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13.6

  	
   

  	
  92856

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13.6

  	
   

  	
  92863

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13.6

  	
   

  	
  92864

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13.7

  	
   

  	
  92613

  	
   

  

 

45

 

	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13.7

  	
   

  	
  92867

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.2

  	
   

  	
  92866

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.3

  	
   

  	
  92666

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  15.2

  	
   

  	
  92859

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  15.6

  	
   

  	
  92667

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  16.4

  	
   

  	
  92869

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  16.7

  	
   

  	
  92669

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  22.7

  	
   

  	
  92862

  	
   

  
	
  PALOS VERDES PENINSULA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.4

  	
   

  	
  90274

  	
   

  
	
  PARAMOUNT

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  10.6

  	
   

  	
  90723

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.2

  	
   

  	
  91131

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.2

  	
   

  	
  91185

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.2

  	
   

  	
  91187

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.2

  	
   

  	
  91191

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.5

  	
   

  	
  91186

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.2

  	
   

  	
  91117

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.2

  	
   

  	
  91121

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.6

  	
   

  	
  91106

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.7

  	
   

  	
  91107

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.7

  	
   

  	
  91125

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.7

  	
   

  	
  91126

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.4

  	
   

  	
  91175

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.6

  	
   

  	
  91116.

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.8

  	
   

  	
  91101

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.8

  	
   

  	
  91104

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.8

  	
   

  	
  91189

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.9

  	
   

  	
  91115

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.2

  	
   

  	
  91100

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.2

  	
   

  	
  91105

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.2

  	
   

  	
  91182

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.3

  	
   

  	
  91188

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.4

  	
   

  	
  91184

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.6

  	
   

  	
  91129

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.7

  	
   

  	
  91123

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.7

  	
   

  	
  91124

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.1

  	
   

  	
  91114

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.1

  	
   

  	
  91122

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.1

  	
   

  	
  91127

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.1

  	
   

  	
  91128

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.2

  	
   

  	
  91102

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.2

  	
   

  	
  91109

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.2

  	
   

  	
  91110

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.8

  	
   

  	
  91103

  	
   

  
	
  PICO RIVERA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  11.8

  	
   

  	
  90662

  	
   

  
	
  PICO RIVERA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.2

  	
   

  	
  90665

  	
   

  
	
  PICO RIVERA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.7

  	
   

  	
  90660

  	
   

  

 

46

 

	
  PICO RIVERA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.9

  	
   

  	
  90661

  	
   

  
	
  PLACENTIA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.3

  	
   

  	
  92871

  	
   

  
	
  PLACENTIA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.4

  	
   

  	
  92670

  	
   

  
	
  PLACENTIA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.5

  	
   

  	
  92870

  	
   

  
	
  PLACENTIA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.9

  	
   

  	
  92601

  	
   

  
	
  PLAYA DEL REY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28

  	
   

  	
  90293

  	
   

  
	
  PLAYA DEL REY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.1

  	
   

  	
  90296

  	
   

  
	
  POMONA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.2

  	
   

  	
  91768

  	
   

  
	
  POMONA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.4

  	
   

  	
  91766

  	
   

  
	
  POMONA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.5

  	
   

  	
  91769

  	
   

  
	
  POMONA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.6

  	
   

  	
  91799

  	
   

  
	
  POMONA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.5

  	
   

  	
  91767

  	
   

  
	
  RANCHO PALOS VERDES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.3

  	
   

  	
  90275

  	
   

  
	
  REDONDO BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.8

  	
   

  	
  90278

  	
   

  
	
  REDONDO BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.3

  	
   

  	
  90277

  	
   

  
	
  ROSEMEAD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17

  	
   

  	
  91770

  	
   

  
	
  ROSEMEAD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.3

  	
   

  	
  91771

  	
   

  
	
  ROSEMEAD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.3

  	
   

  	
  91772

  	
   

  
	
  ROWLAND HEIGHTS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.9

  	
   

  	
  91748

  	
   

  
	
  SAN DIMAS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.9

  	
   

  	
  91773

  	
   

  
	
  SAN GABRIEL

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.4

  	
   

  	
  91778

  	
   

  
	
  SAN GABRIEL

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.5

  	
   

  	
  91776

  	
   

  
	
  SAN GABRIEL

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.4

  	
   

  	
  91775

  	
   

  
	
  SAN MARINO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.7

  	
   

  	
  91118

  	
   

  
	
  SAN MARINO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23

  	
   

  	
  91108

  	
   

  
	
  SAN PEDRO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20

  	
   

  	
  90733

  	
   

  
	
  SAN PEDRO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.4

  	
   

  	
  90734

  	
   

  
	
  SAN PEDRO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.9

  	
   

  	
  90731

  	
   

  
	
  SAN PEDRO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.2

  	
   

  	
  90732

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.2

  	
   

  	
  92703

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13.6

  	
   

  	
  92704

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.4

  	
   

  	
  92706

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.8

  	
   

  	
  92712

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  15.2

  	
   

  	
  92702

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  15.4

  	
   

  	
  92711

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  15.5

  	
   

  	
  92725

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  16.5

  	
   

  	
  92701

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  16.5

  	
   

  	
  92799

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  17.9

  	
   

  	
  92707

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  18

  	
   

  	
  92705

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  18

  	
   

  	
  92735

  	
   

  
	
  SANTA FE SPRINGS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  3.5

  	
   

  	
  90670

  	
   

  
	
  SANTA FE SPRINGS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.5

  	
   

  	
  90671

  	
   

  
	
  SEAL BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.7

  	
   

  	
  90740

  	
   

  
	
  SIERRA MADRE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.4

  	
   

  	
  91025

  	
   

  
	
  SIERRA MADRE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.1

  	
   

  	
  91024

  	
   

  
	
  SILVERADO

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  27.7

  	
   

  	
  92676

  	
   

  

 

47

 

	
  SOUTH EL MONTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.6

  	
   

  	
  91733

  	
   

  
	
  SOUTH GATE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.1

  	
   

  	
  90280

  	
   

  
	
  SOUTH PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.5

  	
   

  	
  91031

  	
   

  
	
  SOUTH PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.8

  	
   

  	
  91030

  	
   

  
	
  STANTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.9

  	
   

  	
  90680

  	
   

  
	
  SUNSET BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.5

  	
   

  	
  90742

  	
   

  
	
  SURFSIDE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.4

  	
   

  	
  90743

  	
   

  
	
  TEMPLE CITY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.5

  	
   

  	
  91780

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.5

  	
   

  	
  90502

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.7

  	
   

  	
  90507

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.7

  	
   

  	
  90508

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.7

  	
   

  	
  90501

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.7

  	
   

  	
  90509

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.7

  	
   

  	
  90510

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18

  	
   

  	
  90500

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18

  	
   

  	
  90503

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.7

  	
   

  	
  90504

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19

  	
   

  	
  90506

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.1

  	
   

  	
  90505

  	
   

  
	
  TUSTIN

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  17.8

  	
   

  	
  92681

  	
   

  
	
  TUSTIN

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  17.8

  	
   

  	
  92781

  	
   

  
	
  TUSTIN

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  18.6

  	
   

  	
  92680

  	
   

  
	
  TUSTIN

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  19.1

  	
   

  	
  92780

  	
   

  
	
  TUSTIN

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  19.9

  	
   

  	
  92782

  	
   

  
	
  TUSTIN

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  20.2

  	
   

  	
  92710

  	
   

  
	
  VILLA PARK

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.9

  	
   

  	
  92861

  	
   

  
	
  WALNUT

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.7

  	
   

  	
  91795

  	
   

  
	
  WALNUT

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.1

  	
   

  	
  91788

  	
   

  
	
  WALNUT

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.1

  	
   

  	
  91789

  	
   

  
	
  WEST COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.3

  	
   

  	
  91790

  	
   

  
	
  WEST COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19

  	
   

  	
  91792

  	
   

  
	
  WEST COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.5

  	
   

  	
  91791

  	
   

  
	
  WEST COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.9

  	
   

  	
  91793

  	
   

  
	
  WESTMINSTER

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.1

  	
   

  	
  92684

  	
   

  
	
  WESTMINSTER

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8.7

  	
   

  	
  92685

  	
   

  
	
  WESTMINSTER

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.3

  	
   

  	
  92683

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  7.8

  	
   

  	
  90604

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  8.4

  	
   

  	
  90605

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  8.4

  	
   

  	
  90607

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  8.4

  	
   

  	
  90612

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  8.6

  	
   

  	
  90603

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  8.7

  	
   

  	
  90609

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.4

  	
   

  	
  90608

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.6

  	
   

  	
  90602

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  10.2

  	
   

  	
  90606

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  10.3

  	
   

  	
  90610

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  11.2

  	
   

  	
  90601

  	
   

  

 

48

 

	
  WILMINGTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.6

  	
   

  	
  90744

  	
   

  
	
  WILMINGTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.5

  	
   

  	
  90748

  	
   

  
	
  YORBA LINDA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.4

  	
   

  	
  92886

  	
   

  
	
  YORBA LINDA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.9

  	
   

  	
  92885

  	
   

  
	
  YORBA LINDA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  15.7

  	
   

  	
  92686

  	
   

  
	
  YORBA LINDA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  18.3

  	
   

  	
  92687

  	
   

  
	
  YORBA LINDA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  20.8

  	
   

  	
  92887

  	
   

  

 

49

 

EXHIBIT A-1.1

 

NORTHWEST ORANGE COUNTY MEDICAL GROUP - WEST
ANAHEIM

ZIP CODES

 

Within 30 miles -92804

 

	
  City

  	
   

  	
  County

  	
   

  	
  State

  	
   

  	
  AVGDIST

  	
   

  	
  ZIP

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26

  	
   

  	
  91803

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.5

  	
   

  	
  91841

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.5

  	
   

  	
  91899

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.6

  	
   

  	
  91802

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.6

  	
   

  	
  91804

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.6

  	
   

  	
  91896

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.7

  	
   

  	
  91800

  	
   

  
	
  ALHAMBRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.8

  	
   

  	
  91801

  	
   

  
	
  ALISO VIEJO

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  15.3

  	
   

  	
  92698

  	
   

  
	
  ALISO VIEJO

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  26.2

  	
   

  	
  92656

  	
   

  
	
  ALISO VIEJO

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  26.9

  	
   

  	
  92637

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  0.6

  	
   

  	
  92814

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  0.9

  	
   

  	
  92804

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  2.1

  	
   

  	
  92815

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  2.3

  	
   

  	
  92812

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  2.7

  	
   

  	
  92809

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  3.3

  	
   

  	
  92803

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  3.3

  	
   

  	
  92850

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  3.5

  	
   

  	
  92801

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  3.5

  	
   

  	
  92802

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.1

  	
   

  	
  92825

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.2

  	
   

  	
  92800

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.3

  	
   

  	
  92805

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6.1

  	
   

  	
  92816

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6.6

  	
   

  	
  92806

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.6

  	
   

  	
  92807

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.9

  	
   

  	
  92817

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12

  	
   

  	
  92899

  	
   

  
	
  ANAHEIM

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13.9

  	
   

  	
  92808

  	
   

  
	
  ARCADIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.6

  	
   

  	
  91066

  	
   

  
	
  ARCADIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.6

  	
   

  	
  91077

  	
   

  
	
  ARCADIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.8

  	
   

  	
  91007

  	
   

  
	
  ARCADIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.4

  	
   

  	
  91006

  	
   

  
	
  ARTESIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.7

  	
   

  	
  90701

  	
   

  
	
  ARTESIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  10.6

  	
   

  	
  90702

  	
   

  
	
  ATWOOD

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.9

  	
   

  	
  92811

  	
   

  
	
  AZUSA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.8

  	
   

  	
  91702

  	
   

  
	
  BALDWIN PARK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.1

  	
   

  	
  91797

  	
   

  
	
  BALDWIN PARK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.1

  	
   

  	
  91706

  	
   

  
	
  BELL

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.8

  	
   

  	
  90201

  	
   

  

 

50

 

	
  BELL GARDENS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23

  	
   

  	
  90202

  	
   

  
	
  BELLFLOWER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.4

  	
   

  	
  90706

  	
   

  
	
  BELLFLOWER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.8

  	
   

  	
  90707

  	
   

  
	
  BREA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.2

  	
   

  	
  92821

  	
   

  
	
  BREA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.8

  	
   

  	
  92622

  	
   

  
	
  BREA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.8

  	
   

  	
  92822

  	
   

  
	
  BREA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.4

  	
   

  	
  92621

  	
   

  
	
  BREA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  15.2

  	
   

  	
  92823

  	
   

  
	
  BUENA PARK

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.1

  	
   

  	
  90622

  	
   

  
	
  BUENA PARK

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.5

  	
   

  	
  90620

  	
   

  
	
  BUENA PARK

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6.4

  	
   

  	
  90621

  	
   

  
	
  BUENA PARK

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6.4

  	
   

  	
  90624

  	
   

  
	
  CARSON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.9

  	
   

  	
  90749

  	
   

  
	
  CARSON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.7

  	
   

  	
  90745

  	
   

  
	
  CARSON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.9

  	
   

  	
  90747

  	
   

  
	
  CARSON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.8

  	
   

  	
  90746

  	
   

  
	
  CERRITOS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  8.8

  	
   

  	
  90703

  	
   

  
	
  CHINO

  	
   

  	
  SAN
  BERNARDINO

  	
   

  	
  CA

  	
   

  	
  27.2

  	
   

  	
  91708

  	
   

  
	
  CHINO

  	
   

  	
  SAN
  BERNARDINO

  	
   

  	
  CA

  	
   

  	
  27.5

  	
   

  	
  91710

  	
   

  
	
  CHINO HILLS

  	
   

  	
  SAN
  BERNARDINO

  	
   

  	
  CA

  	
   

  	
  19.1

  	
   

  	
  91709

  	
   

  
	
  CITY OF INDUSTRY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.6

  	
   

  	
  91715

  	
   

  
	
  CITY OF INDUSTRY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.6

  	
   

  	
  91716

  	
   

  
	
  COMPTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.4

  	
   

  	
  90220

  	
   

  
	
  COMPTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.1

  	
   

  	
  90224

  	
   

  
	
  COMPTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.2

  	
   

  	
  90221

  	
   

  
	
  COMPTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.9

  	
   

  	
  90223

  	
   

  
	
  COMPTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.3

  	
   

  	
  90222

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  20.6

  	
   

  	
  92882

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  22.9

  	
   

  	
  92881

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  23.4

  	
   

  	
  91720

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  25.5

  	
   

  	
  92878

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  25.5

  	
   

  	
  92880

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  25.6

  	
   

  	
  91718

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  25.8

  	
   

  	
  92877

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  26.2

  	
   

  	
  91719

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  27.5

  	
   

  	
  92883

  	
   

  
	
  CORONA

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  28.9

  	
   

  	
  92879

  	
   

  
	
  CORONA DEL MAR

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  19.2

  	
   

  	
  92625

  	
   

  
	
  COSTA MESA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.1

  	
   

  	
  92628

  	
   

  
	
  COSTA MESA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.2

  	
   

  	
  92626

  	
   

  
	
  COSTA MESA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.7

  	
   

  	
  92627

  	
   

  
	
  COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.9

  	
   

  	
  91722

  	
   

  
	
  COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.9

  	
   

  	
  91723

  	
   

  
	
  COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.5

  	
   

  	
  91724

  	
   

  

 

51

 

	
  CYPRESS

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.3

  	
   

  	
  90630

  	
   

  
	
  DIAMOND BAR

  	
   

  	
  OS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.2

  	
   

  	
  91765

  	
   

  
	
  DOWNEY

  	
   

  	
  OS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.7

  	
   

  	
  90241

  	
   

  
	
  DOWNEY

  	
   

  	
  OS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.3

  	
   

  	
  90239

  	
   

  
	
  DOWNEY

  	
   

  	
  OS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.1

  	
   

  	
  90240

  	
   

  
	
  DOWNEY

  	
   

  	
  OS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.5

  	
   

  	
  90242

  	
   

  
	
  DUARTE

  	
   

  	
  OS ANGELES

  	
   

  	
  CA

  	
   

  	
  23

  	
   

  	
  91009

  	
   

  
	
  DUARTE

  	
   

  	
  OS ANGELES

  	
   

  	
  CA

  	
   

  	
  23

  	
   

  	
  91010

  	
   

  
	
  EAST IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  19

  	
   

  	
  92650

  	
   

  
	
  EL MONTE

  	
   

  	
  OS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.2

  	
   

  	
  91732

  	
   

  
	
  EL MONTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.9

  	
   

  	
  91731

  	
   

  
	
  EL MONTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.2

  	
   

  	
  91734

  	
   

  
	
  EL MONTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.8

  	
   

  	
  91735

  	
   

  
	
  EL TORO

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  25

  	
   

  	
  92609

  	
   

  
	
  FOOTHILL RANCH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  21.1

  	
   

  	
  92610

  	
   

  
	
  FOUNTAIN VALLEY

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.2

  	
   

  	
  92708

  	
   

  
	
  FOUNTAIN VALLEY

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8.1

  	
   

  	
  92728

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  3.6

  	
   

  	
  92833

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.5

  	
   

  	
  92837

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.7

  	
   

  	
  92633

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.5

  	
   

  	
  92632

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.9

  	
   

  	
  92832

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6

  	
   

  	
  92836

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7

  	
   

  	
  92838

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.3

  	
   

  	
  92634

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.3

  	
   

  	
  92834

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8.2

  	
   

  	
  92631

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8.7

  	
   

  	
  92635

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8.9

  	
   

  	
  92831

  	
   

  
	
  FULLERTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.5

  	
   

  	
  92835

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  2.3

  	
   

  	
  92840

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  2.3

  	
   

  	
  92841

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  2.5

  	
   

  	
  92641

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  2.6

  	
   

  	
  92642

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  2.6

  	
   

  	
  92842

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  3.2

  	
   

  	
  92640

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  3.5

  	
   

  	
  92844

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  3.7

  	
   

  	
  92644

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.6

  	
   

  	
  92643

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.9

  	
   

  	
  92843

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.4

  	
   

  	
  92846

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.6

  	
   

  	
  92645

  	
   

  
	
  GARDEN GROVE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.8

  	
   

  	
  92845

  	
   

  
	
  GARDENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.4

  	
   

  	
  90248

  	
   

  
	
  GARDENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.4

  	
   

  	
  90247

  	
   

  
	
  GARDENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.6

  	
   

  	
  90249

  	
   

  
	
  GLENDORA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.5

  	
   

  	
  91740

  	
   

  

 

52

 

	
  GLENDORA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.1

  	
   

  	
  91741

  	
   

  
	
  HACIENDA HEIGHTS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.8

  	
   

  	
  91745

  	
   

  
	
  HARBOR CITY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.7

  	
   

  	
  90710

  	
   

  
	
  HAWAIIAN GARDENS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  7.8

  	
   

  	
  90716

  	
   

  
	
  HAWTHORNE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.9

  	
   

  	
  90250

  	
   

  
	
  HAWTHORNE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.2

  	
   

  	
  90251

  	
   

  
	
  HERMOSA BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.2

  	
   

  	
  90254

  	
   

  
	
  HUNTINGTON BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.5

  	
   

  	
  92605

  	
   

  
	
  HUNTINGTON BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8.1

  	
   

  	
  92647

  	
   

  
	
  HUNTINGTON BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10

  	
   

  	
  92646

  	
   

  
	
  HUNTINGTON BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.4

  	
   

  	
  92648

  	
   

  
	
  HUNTINGTON BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11

  	
   

  	
  92649

  	
   

  
	
  HUNTINGTON BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.1

  	
   

  	
  92615

  	
   

  
	
  HUNTINGTON PARK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.2

  	
   

  	
  90255

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.9

  	
   

  	
  90310

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.4

  	
   

  	
  90303

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29

  	
   

  	
  90305

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.2

  	
   

  	
  90304

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.8

  	
   

  	
  90306

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.8

  	
   

  	
  90307

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.8

  	
   

  	
  90308

  	
   

  
	
  INGLEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.8

  	
   

  	
  90313

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.8

  	
   

  	
  92623

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  15.3

  	
   

  	
  92606

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  16.3

  	
   

  	
  92714

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  16.5

  	
   

  	
  92612

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  16.7

  	
   

  	
  92602

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  16.7

  	
   

  	
  92697

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  16.7

  	
   

  	
  92720

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  17

  	
   

  	
  92616

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  17

  	
   

  	
  92717

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  17.8

  	
   

  	
  92604

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  17.9

  	
   

  	
  92614

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  17.9

  	
   

  	
  92715

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  18

  	
   

  	
  92620

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  19.1

  	
   

  	
  92619

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  19.1

  	
   

  	
  92713

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  19.1

  	
   

  	
  92716

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  19.1

  	
   

  	
  92730

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  19.9

  	
   

  	
  92618

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  20.2

  	
   

  	
  92709

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  21.9

  	
   

  	
  92603

  	
   

  
	
  IRVINE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  21.9

  	
   

  	
  92718

  	
   

  
	
  LA CANADA FLINTRIDGE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.7

  	
   

  	
  91011

  	
   

  
	
  LA HABRA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.4

  	
   

  	
  90632

  	
   

  
	
  LA HABRA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.9

  	
   

  	
  90631

  	
   

  
	
  LA HABRA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  10.1

  	
   

  	
  90633

  	
   

  

 

53

 

	
  LA MIRADA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  8.3

  	
   

  	
  90637

  	
   

  
	
  LA MIRADA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  8.5

  	
   

  	
  90638

  	
   

  
	
  LA MIRADA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.5

  	
   

  	
  90639

  	
   

  
	
  LA PALMA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7

  	
   

  	
  90623

  	
   

  
	
  LA PUENTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.5

  	
   

  	
  91749

  	
   

  
	
  LA PUENTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.5

  	
   

  	
  91714

  	
   

  
	
  LA PUENTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.9

  	
   

  	
  91747

  	
   

  
	
  LA PUENTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16

  	
   

  	
  91744

  	
   

  
	
  LA PUENTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.3

  	
   

  	
  91746

  	
   

  
	
  LAGUNA BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  25.9

  	
   

  	
  92652

  	
   

  
	
  LACUNA BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  26.7

  	
   

  	
  92651

  	
   

  
	
  LAGUNA HILLS

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  25

  	
   

  	
  92653

  	
   

  
	
  LAGUNA HILLS

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  25.4

  	
   

  	
  92654

  	
   

  
	
  LAGUNA NIGUEL

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  29.1

  	
   

  	
  92607

  	
   

  
	
  LAKE FOREST

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  25.5

  	
   

  	
  92630

  	
   

  
	
  LAKEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  8.1

  	
   

  	
  90715

  	
   

  
	
  LAKEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  11.5

  	
   

  	
  90713

  	
   

  
	
  LAKEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.5

  	
   

  	
  90711

  	
   

  
	
  LAKEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.5

  	
   

  	
  90714

  	
   

  
	
  LAKEWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.9

  	
   

  	
  90712

  	
   

  
	
  LAWN DALE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.7

  	
   

  	
  90260

  	
   

  
	
  LAWN DALE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.1

  	
   

  	
  90261

  	
   

  
	
  LOMITA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.3

  	
   

  	
  90717

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  10.7

  	
   

  	
  90840

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  11.2

  	
   

  	
  90815

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  11.7

  	
   

  	
  90809

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  11.7

  	
   

  	
  90846

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  11.7

  	
   

  	
  90888

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  11.8

  	
   

  	
  90808

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  11.9

  	
   

  	
  90803

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.5

  	
   

  	
  90804

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.6

  	
   

  	
  90755

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.7

  	
   

  	
  90842

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.9

  	
   

  	
  90853

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.2

  	
   

  	
  90806

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.2

  	
   

  	
  90814

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.7

  	
   

  	
  90807

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.7

  	
   

  	
  90847

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.7

  	
   

  	
  90848

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.4

  	
   

  	
  90801

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.4

  	
   

  	
  90844

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.4

  	
   

  	
  90845

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.6

  	
   

  	
  90800

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16

  	
   

  	
  90810

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.1

  	
   

  	
  90805

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.1

  	
   

  	
  90813

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.2

  	
   

  	
  90831

  	
   

  

 

54

 

	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.2

  	
   

  	
  90833

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.2

  	
   

  	
  90834

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.2

  	
   

  	
  90835

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.2

  	
   

  	
  90899

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.3

  	
   

  	
  90832

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.9

  	
   

  	
  90802

  	
   

  
	
  LONG BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.4

  	
   

  	
  90822

  	
   

  
	
  LOS ALAMITOS

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6.5

  	
   

  	
  90721

  	
   

  
	
  LOS ALAMITOS

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8.2

  	
   

  	
  90720

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.4

  	
   

  	
  90040

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.3

  	
   

  	
  90091

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.5

  	
   

  	
  90101

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.5

  	
   

  	
  90103

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.7

  	
   

  	
  90059

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.1

  	
   

  	
  90002

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.6

  	
   

  	
  90061

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.1

  	
   

  	
  90022

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.4

  	
   

  	
  90023

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.9

  	
   

  	
  90044

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.4

  	
   

  	
  90003

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.4

  	
   

  	
  90058

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.4

  	
   

  	
  90097

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.5

  	
   

  	
  90102

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.9

  	
   

  	
  90185

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26

  	
   

  	
  90001

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26

  	
   

  	
  90052

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26

  	
   

  	
  90174

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.1

  	
   

  	
  90047

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.1

  	
   

  	
  90063

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.7

  	
   

  	
  90033

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.9

  	
   

  	
  90021

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.3

  	
   

  	
  90011

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.3

  	
   

  	
  90032

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.4

  	
   

  	
  90082

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.6

  	
   

  	
  90013

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.6

  	
   

  	
  90037

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29

  	
   

  	
  90031

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.2

  	
   

  	
  90014

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.3

  	
   

  	
  90012

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.3

  	
   

  	
  90045

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.5

  	
   

  	
  90043

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.5

  	
   

  	
  90053

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.5

  	
   

  	
  90079

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.6

  	
   

  	
  90015

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.7

  	
   

  	
  90007

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.7

  	
   

  	
  90062

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.8

  	
   

  	
  90030

  	
   

  

 

55

 

	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.8

  	
   

  	
  90051

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.8

  	
   

  	
  90054

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.8

  	
   

  	
  90060

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.8

  	
   

  	
  90086

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.8

  	
   

  	
  90087

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.8

  	
   

  	
  90089

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.9

  	
   

  	
  90055

  	
   

  
	
  LOS ANGELES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.9

  	
   

  	
  90099

  	
   

  
	
  LYNWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.3

  	
   

  	
  90262

  	
   

  
	
  MANHATTAN BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.6

  	
   

  	
  90267

  	
   

  
	
  MANHATTAN BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.3

  	
   

  	
  90266

  	
   

  
	
  MAYWOOD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.3

  	
   

  	
  90270

  	
   

  
	
  MIDWAY CITY

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6.5

  	
   

  	
  92655

  	
   

  
	
  MISSION VIEJO

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  25.9

  	
   

  	
  92691

  	
   

  
	
  MISSION VIEJO

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  29.2

  	
   

  	
  92692

  	
   

  
	
  MONROVIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.1

  	
   

  	
  91016

  	
   

  
	
  MONROVIA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25

  	
   

  	
  91017

  	
   

  
	
  MONTCLAIR

  	
   

  	
  SAN
  BERNARDINO

  	
   

  	
  CA

  	
   

  	
  28.8

  	
   

  	
  91763

  	
   

  
	
  MONTEBELLO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.9

  	
   

  	
  90640

  	
   

  
	
  MONTEREY PARK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.4

  	
   

  	
  91755

  	
   

  
	
  MONTEREY PARK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.2

  	
   

  	
  91756

  	
   

  
	
  MONTEREY PARK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.4

  	
   

  	
  91754

  	
   

  
	
  NEWPORT BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13.1

  	
   

  	
  92663

  	
   

  
	
  NEWPORT BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.5

  	
   

  	
  92659

  	
   

  
	
  NEWPORT BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  16

  	
   

  	
  92658

  	
   

  
	
  NEWPORT BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  16.3

  	
   

  	
  92660

  	
   

  
	
  NEWPORT BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  18.2

  	
   

  	
  92661

  	
   

  
	
  NEWPORT BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  18.2

  	
   

  	
  92662

  	
   

  
	
  NEWPORT COAST

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  20.4

  	
   

  	
  92657

  	
   

  
	
  NORCO

  	
   

  	
  RIVERSIDE

  	
   

  	
  CA

  	
   

  	
  27.4

  	
   

  	
  91760

  	
   

  
	
  NORWALK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.7

  	
   

  	
  90651

  	
   

  
	
  NORWALK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.1

  	
   

  	
  90650

  	
   

  
	
  NORWALK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.3

  	
   

  	
  90652

  	
   

  
	
  NORWALK

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.4

  	
   

  	
  90659

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.1

  	
   

  	
  92664

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.7

  	
   

  	
  92868

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6.2

  	
   

  	
  92668

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.2

  	
   

  	
  92856

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.3

  	
   

  	
  92613

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.3

  	
   

  	
  92863

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.3

  	
   

  	
  92864

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.4

  	
   

  	
  92867

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.6

  	
   

  	
  92665

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.8

  	
   

  	
  92857

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.9

  	
   

  	
  92866

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8

  	
   

  	
  92666

  	
   

  

 

56

 

	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8

  	
   

  	
  92865

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8.9

  	
   

  	
  92859

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.3

  	
   

  	
  92667

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.1

  	
   

  	
  92869

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.4

  	
   

  	
  92669

  	
   

  
	
  ORANGE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  19

  	
   

  	
  92862

  	
   

  
	
  PALOS VERDES PENINSULA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25

  	
   

  	
  90274

  	
   

  
	
  PARAMOUNT

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.8

  	
   

  	
  90723

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.8

  	
   

  	
  91131

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.8

  	
   

  	
  91185

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.8

  	
   

  	
  91187

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.8

  	
   

  	
  91191

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.9

  	
   

  	
  91186

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.6

  	
   

  	
  91117

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.6

  	
   

  	
  91121

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.1

  	
   

  	
  91106

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.1

  	
   

  	
  91107

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.2

  	
   

  	
  91125

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.2

  	
   

  	
  91126

  	
   

  
	
  PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.9

  	
   

  	
  91175

  	
   

  
	
  PICO RIVERA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.8

  	
   

  	
  90662

  	
   

  
	
  PICO RIVERA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.1

  	
   

  	
  90665

  	
   

  
	
  PICO RIVERA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.6

  	
   

  	
  90660

  	
   

  
	
  PICO RIVERA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.8

  	
   

  	
  90661

  	
   

  
	
  PLACENTIA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.3

  	
   

  	
  92871

  	
   

  
	
  PLACENTIA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.4

  	
   

  	
  92670

  	
   

  
	
  PLACENTIA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.4

  	
   

  	
  92870

  	
   

  
	
  PLACENTIA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.7

  	
   

  	
  92601

  	
   

  
	
  POMONA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.7

  	
   

  	
  91768

  	
   

  
	
  POMONA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.8

  	
   

  	
  91766

  	
   

  
	
  POMONA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26

  	
   

  	
  91769

  	
   

  
	
  POMONA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26

  	
   

  	
  91799

  	
   

  
	
  POMONA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28

  	
   

  	
  91767

  	
   

  
	
  RANCHO PALOS VERDES

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.9

  	
   

  	
  90275

  	
   

  
	
  RANCHO SANTA MARGARITA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  29.6

  	
   

  	
  92688

  	
   

  
	
  REDONDO BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.1

  	
   

  	
  90277

  	
   

  
	
  REDONDO BEACH

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.8

  	
   

  	
  90278

  	
   

  
	
  ROSEMEAD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.7

  	
   

  	
  91770

  	
   

  
	
  ROSEMEAD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23

  	
   

  	
  91771

  	
   

  
	
  ROSEMEAD

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23

  	
   

  	
  91772

  	
   

  
	
  ROWLAND HEIGHTS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.4

  	
   

  	
  91748

  	
   

  
	
  SAN DIMAS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25.7

  	
   

  	
  91773

  	
   

  
	
  SAN GABRIEL

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26

  	
   

  	
  91778

  	
   

  
	
  SAN GABRIEL

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.1

  	
   

  	
  91776

  	
   

  

 

57

 

	
  SAN GABRIEL

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  26.9

  	
   

  	
  91775

  	
   

  
	
  SAN MARINO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.2

  	
   

  	
  91118

  	
   

  
	
  SAN MARINO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.5

  	
   

  	
  91108

  	
   

  
	
  SAN PEDRO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.3

  	
   

  	
  90733

  	
   

  
	
  SAN PEDRO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.8

  	
   

  	
  90734

  	
   

  
	
  SAN PEDRO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.2

  	
   

  	
  90731

  	
   

  
	
  SAN PEDRO

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.5

  	
   

  	
  90732

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  5.9

  	
   

  	
  92703

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  7.4

  	
   

  	
  92704

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8.2

  	
   

  	
  92706

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  8.5

  	
   

  	
  92712

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9

  	
   

  	
  92702

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.2

  	
   

  	
  92711

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.3

  	
   

  	
  92725

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.4

  	
   

  	
  92799

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  10.4

  	
   

  	
  92701

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.8

  	
   

  	
  92705

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.9

  	
   

  	
  92707

  	
   

  
	
  SANTA ANA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.9

  	
   

  	
  92735

  	
   

  
	
  SANTA FE SPRINGS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  9.9

  	
   

  	
  90670

  	
   

  
	
  SANTA FE SPRINGS

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.7

  	
   

  	
  90671

  	
   

  
	
  SEAL BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.6

  	
   

  	
  90740

  	
   

  
	
  SIERRA MADRE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  27.8

  	
   

  	
  91025

  	
   

  
	
  SIERRA MADRE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  28.4

  	
   

  	
  91024

  	
   

  
	
  SILVERADO

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  23.1

  	
   

  	
  92676

  	
   

  
	
  SOUTH EL MONTE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.3

  	
   

  	
  91733

  	
   

  
	
  SOUTH GATE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.1

  	
   

  	
  90280

  	
   

  
	
  SOUTH PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.1

  	
   

  	
  91031

  	
   

  
	
  SOUTH PASADENA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  29.4

  	
   

  	
  91030

  	
   

  
	
  STANTON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  1.8

  	
   

  	
  90680

  	
   

  
	
  SUNSET BEACH

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.2

  	
   

  	
  90742

  	
   

  
	
  SURFSIDE

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.2

  	
   

  	
  90743

  	
   

  
	
  TEMPLE CITY

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.1

  	
   

  	
  91780

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  19.9

  	
   

  	
  90502

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.6

  	
   

  	
  90501

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.7

  	
   

  	
  90507

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  21.7

  	
   

  	
  90508

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.3

  	
   

  	
  90509

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.3

  	
   

  	
  90510

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.4

  	
   

  	
  90503

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  22.9

  	
   

  	
  90505

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  23.2

  	
   

  	
  90500

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  24.8

  	
   

  	
  90504

  	
   

  
	
  TORRANCE

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  25

  	
   

  	
  90506

  	
   

  
	
  TRABUCO CANYON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  27.8

  	
   

  	
  92679

  	
   

  
	
  TRA6UCO CANYON

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  28.5

  	
   

  	
  92678

  	
   

  
	
  TUSTIN

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.7

  	
   

  	
  92681

  	
   

  

 

58

 

	
  TUSTIN

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  11.7

  	
   

  	
  92781

  	
   

  
	
  TUSTIN

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.5

  	
   

  	
  92680

  	
   

  
	
  TUSTIN

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13

  	
   

  	
  92780

  	
   

  
	
  TUSTIN

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13.8

  	
   

  	
  92782

  	
   

  
	
  TUSTIN

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  14.1

  	
   

  	
  92710

  	
   

  
	
  VILLA PARK

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  9.3

  	
   

  	
  92861

  	
   

  
	
  WALNUT

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.1

  	
   

  	
  91795

  	
   

  
	
  WALNUT

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.5

  	
   

  	
  91788

  	
   

  
	
  WALNUT

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  20.7

  	
   

  	
  91789

  	
   

  
	
  WEST COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.2

  	
   

  	
  91790

  	
   

  
	
  WEST COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.6

  	
   

  	
  91792

  	
   

  
	
  WEST COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.2

  	
   

  	
  91791

  	
   

  
	
  WEST COVINA

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.8

  	
   

  	
  91793

  	
   

  
	
  WESTMINSTER

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  4.7

  	
   

  	
  92683

  	
   

  
	
  WESTMINSTER

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6

  	
   

  	
  92684

  	
   

  
	
  WESTMINSTER

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  6.8

  	
   

  	
  92685

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  10.4

  	
   

  	
  90604

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  11.4

  	
   

  	
  90609

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  11.8

  	
   

  	
  90603

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  12.7

  	
   

  	
  90605

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.5

  	
   

  	
  90612

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  13.6

  	
   

  	
  90607

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  14.8

  	
   

  	
  90602

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  15.4

  	
   

  	
  90608

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.2

  	
   

  	
  90606

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  16.3

  	
   

  	
  90610

  	
   

  
	
  WHITTIER

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.1

  	
   

  	
  90601

  	
   

  
	
  WILMINGTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  17.1

  	
   

  	
  90744

  	
   

  
	
  WILMINGTON

  	
   

  	
  LOS ANGELES

  	
   

  	
  CA

  	
   

  	
  18.9

  	
   

  	
  90748

  	
   

  
	
  YORBA LINDA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.3

  	
   

  	
  92886

  	
   

  
	
  YORBA LINDA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  12.8

  	
   

  	
  92885

  	
   

  
	
  YORBA LINDA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  13.5

  	
   

  	
  92686

  	
   

  
	
  YORBA LINDA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  16

  	
   

  	
  92687

  	
   

  
	
  YORBA LINDA

  	
   

  	
  ORANGE

  	
   

  	
  CA

  	
   

  	
  18.5

  	
   

  	
  92887

  	
   

  

 

59

 

EXHIBIT B

 

HMO IPA/Medical Group Agreement

DIVISION
OF FINANCIAL RESPONSIBILITIES: Effective Date: 02/01/03

NORTHWEST
ORANGE COUNTY MEDICAL GROUP-LA PALMA

 

Pursuant to the disclosure
requirements as set forth in Subchapter 5.5 of Chapter 3 of Title 28,
California Code of Regulations § 1300.75.4.1 (a) the attached Division of
Financial Responsibility (DOFR), informs Group of the allocation of financial
risk assumed under the contract.  The
matrix details the responsibility for medical expenses, including physician,
institutional and ancillary costs, which will be allotted to the group, the
plan and any shared risk funds.

 

	
  BENEFIT

  	
   

  	
  MEDICAL

  GROUP

  	
   

  	
  SHARED

  SAVINGS

  	
   

  	
  BLUE

  SHIELD

  
	
  Abortion:

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  AIDS

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Adult Day
  Care, Non-Medicare covered

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Allergy

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Testing

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Serum

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Ambulance:
  In-Area (Air or Ground)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Emergency (911/Paramedic
  Transport)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inter-facility Transfer

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Other Medical
  Transportation

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Ambulance:
  Out of Area (Air or Ground)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Emergency (911/Paramedic
  Transport)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inter-facility Transfer

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Other Medical Transportation

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Amniocentesis
  (see Genetic Testing)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Anesthetics
  Administration

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Apnea
  Monitor (see DME)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Artificial
  Insemination (see Family Planning)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Artificial
  Limbs (see Prosthetics)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Audiology
  (Hearing Tests)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Biofeedback
  (Outpatient)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Blood and:
  Bipod Products (Outpatient)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  From Blood Bank -
  Transfusions

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Autologous Blood Donation

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Chemotherapy

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Medications Inpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Supplies Inpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Medications Outpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Supplies Outpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Hospital Facility Component
  (if applicable)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  

 

*** All
references to the division of financial responsibility have been deleted.

 

60

 

	
  Chiropractic Medicare approved

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Circumcision

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Contact Lenses

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Intraocular
  Lens (surgical implant)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Incident
  to Cataract surgery (NOT surgical implant)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Standard
  Corrective Lenses

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Corrective Appliances (see Orthotics)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Cosmetic Surgery (Medically Necessary)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Custodial Care

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Dental Services (Post accident/injury – Medicare covered)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Dental Services (Non-Medicare covered)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Routine,
  Including prophylaxis

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Crowns

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Bridges

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Dentures

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Durable Medical Equipment (DME)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient
  DME

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Apnea
  Monitor

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Fetal
  Monitor

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Hearing AIDS

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient
  (SNF)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  In
  Lieu of Hospitalization

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Glucose
  Test Strips

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Emergency Admissions (In Area)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Initial
  Treatment (ER Physician)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Hospital
  Based Physicians (see Hospital Based Physicians)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Other
  Professional Consultations

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Emergency Admissions (Out of Area)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Initial
  Treatment (ER Physician)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Hospital
  Based Physicians (see Hospital Based Physicians

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Other
  Consultations

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Emergency, NO Admission (In Area)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Initial
  Treatment (ER Physician)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Hospital
  Based Physicians

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Other
  Professional Consultations

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Emergency, NO Admission (Out of Area)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  

 

*** All
references to the division of financial responsibility have been deleted.

 

61

 

	
  •                  Facility Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Initial Treatment (ER
  Physician)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Hospital Based Physicians

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Other Consults

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Employment
  Physical

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Endoscopic
  Studies

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  With Biopsy

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Without Biopsy

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility Component (if
  performed in Hospital)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility Component
  (office/clinic)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Experimental
  Procedures

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Family
  Planning (including infertility Dx/Tx)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Artificial Insemination

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Diaphragms

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Oral Contraceptives

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  In-Vitro Fertilization/GIFT

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Sterilization

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Reversal of Sterilization

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Genetic
  Testing

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Amniocentesis

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Alphafetoprotein (AFP)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Other

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Health and
  Education

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Individual Patient
  Counseling

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Health Education Programs

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Health
  Evaluation (Physical)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Hearing
  Aids (see DME)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Hearing
  Screening (see Audiology)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Hemodialysis (Acute and Chronic)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient Professional

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient Facility

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient Professional

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient Facility

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Home
  Health Care (Includes IV or Injectables)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  In Lieu of Hospitalization

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Other, Medicare covered

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Other, Non-Medicare covered

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Homemaker

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Home
  Delivered Meals

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Hospice
  Services (Special Medicare Reimbursement Program)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  

 

*** All
references to the division of financial responsibility have been deleted.

 

62

 

	
  •                  Home

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Hospital Based Professionals
  (Inpatient/Outpatient Surgery)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Anesthesiology
  (General)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Anesthesiology (Pain
  Management)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Audiology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Cardiology (non-invasive)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Cardiology
  (invasive)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Cardiopulmonary
  Perfusionist

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Diagnostic
  Services

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Neonatology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Neurology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Nephrology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Pathology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Physical
  Medicine

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Pulmonology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Radiology
  (non-interventional)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Radiology
  (interventional)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Radiation
  Oncology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Surgery

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Hospital Based Professionals (Emergency
  Room)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Anesthesiology
  (General)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Anesthesiology
  (Pain Management)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Audiology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Cardiology
  (non-invasive)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Cardiology
  (invasive)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Cardiopulmonary
  Perfusionist

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Diagnostic
  Services

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Neonatology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Neurology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Nephrology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Pathology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Physical
  Medicine

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Pulmonology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Radiology
  (non-interventional)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Radiology
  (interventional)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Radiation
  Oncology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Surgery

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Hospital Based Professionals (Outpatient
  Diagnostic Testing)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Cardiology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Pathology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Radiology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Other

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Hospitalization, ALL Inpatient Services
  (not otherwise specified herein)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  In Area

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  

 

*** All
references to the division of financial responsibility have been deleted.

 

63

 

	
  •                  Out of Area

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Insulin and Syringes Outpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Insulin

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Syringes

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Lab Services, see Pathology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Lithotripsy

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Mammography (Outpatient)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Medications

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility Take
  Home Drugs

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient
  Medications/Respiratory Therapy

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient
  Medications/Respiratory Therapy

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient Prescription
  Drugs

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Therapeutic
  Injections/Injectables: provided in MD office or Outpatient Setting
  (excluding all childhood immunizations first recommended for use by the
  American Academy of Pediatrics on or after 1-1-01 and Prevnar.

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  All Childhood
  Immunizations first recommended for use by the American Academy of Pediatrics
  on or after 1-1-01 and Prevnar.

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Therapeutic
  Injections/Injectables: provided for self- administration as home use, either
  through contracted Alternative Care Services Provider, a Plan contracted
  pharmacy or Home Health Agency.

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Nuclear Medicine Diagnosis/Treatment

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility
  Component – Inpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility
  Component – Outpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional
  Component – Inpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional
  Component – Outpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Nutritional/Dietetic Counseling
  (Outpatient)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Observation Services/Short Stay (under 24
  hour period)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Emergency Room
  Referral

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient
  Diagnostic Referral

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient Surgery
  Referral

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Obstetrical Care

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Diagnostic
  Services – Outpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  False Labor –
  Outpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Pre-Existing
  Pregnancy

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility –
  Inpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional –
  Inpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Office Visit Supplies

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Organ Transplants (non-experimental)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  

 

*** All
references to the division of financial responsibility have been deleted.

 

64

 

	
  •                  Professional Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Organ Procurement

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Orthotics

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Ostomy Supplies

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Outpatient Surgery

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional Component (See
  Hospital Based Professionals above)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Outpatient Diagnostic Services – FACILITY (including
  but not limited to)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Angiograms

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Aerial Blood Gases

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  CAT Scan

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  2 D Echocardiography

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  EEG

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  EKG

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  EMG

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  ENG

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Fluorescein Angiography

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  GI Lab Diagnostic Test

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Imaging, Routine
  Chest/Skeletal/plain abdominal

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  MRI

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Non-Invasive Vascular
  Studies

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Nuclear Cardiology

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Pulmonary Testing

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Sleep Apnea Studies

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Stress Testing/Treadmills

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Ultrasound

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Pathology Services (Technical Component)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient – Clinical

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient – Anatomical

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient Surgery –
  Clinical

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient Surgery –
  Anatomical

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Personal Care, Non-Medicare covered

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Physical Therapy – see Rehabilitation

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Physician Visits

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  To Hospital

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  To SNF/Custodial Facility

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  To Patient’s Home

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Physician Office visits/Consults

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Podiatry Services

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Pre-Admission Testing (Outpatient Diagnostic)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility Component at
  Hospital

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility Component at
  IPA/Medical Group site

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  

 

*** All
references to the division of financial responsibility have been deleted.

 

65

 

	
  •                  Professional Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Pregnancy – See Obstetrics

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Prosthetic Devices – NOT DME

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Surgically Implanted

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Psychiatric/Substance Abuse Services

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient, Outpatient and
  Office Health Care Professional- Commercial Members who fall under the
  requirements of California’s Assembly Bill 88 (AB88) and whose benefits have
  not been renewed since 7-1-00 and Commercial Members who do not fall under
  the requirements of AB88. Acute detox for all members.

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient, Outpatient and
  Office Health Care Professional-Commercial Members who fall under the
  requirements of AB88 and whose benefits renewed or become effective on or
  after 7/1/00.

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient Facility
  Services-Commercial Members who fall under the requirements of California’s
  AB88 and whose benefits have not been renewed since 7/1/00 and Commercial
  Members who do not fall under the requirements of AB88.  Acute detox for all members

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient Facility Services-Commercial
  Members who fall under the requirements of AB88 and whose benefits renewed or
  become effective on or after 7/1/00

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient Facility
  Services for Day Tx: Commercial Members who fall under the requirements of
  California’s AB88 and whose benefits have not renewed since 7-1-00 and
  Commercial Members who do not fall under the requirements of AB 88.

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient Facility
  Services for Day Tx: Commercial Members who fall under the requirements of
  AB88 and whose benefits renewed or become effective on or after 7/1/00.

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient Facility
  Services for Outpatient Counseling. 
  Commercial Members who fall under the requirements of California’s
  AB88 and whose benefits have not been renewed since 7/1/00 and Commercial
  Members who do not fall under the requirements of AB88

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient Facility
  Services for Outpatient Counseling. 
  Commercial Members who fall under the requirements of AB88 and whose
  benefits renewed or become effective on or after 7/1/00.

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Radiation Therapy

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient Facility
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient Facility
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Radiology Services (Facility)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Emergency Room

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient Diagnostic at
  Hospital – Req. Hos. Facility

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient Diagnostic at
  Hospital – Not Req. Hos. Facility

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  

 

*** All
references to the division of financial responsibility have been deleted.

 

66

 

	
  •                  Outpatient
  Diagnostic at IPA/Medical Group site

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient
  Surgery

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Reconstructive Surgery

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Rehabilitation, Short Term (PT, OT, Speech,
  Cardiac)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Respiratory Therapy

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient
  Facility

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient
  Facility at Hospital

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient
  Facility at IPA/Medical Group site

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Skilled Nursing Facility

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Social Services

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Inpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Sub-Acute Care

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional
  Component

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Surgical/Medical Supplies

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient
  Surgery

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient
  (Home/Custodial)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Outpatient at
  IPA/Medical Group site

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  TMJ Syndrome

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Facility

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Professional

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Dental

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Transfusions (see Blood & Blood
  Products)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Transplants (see Organ Transplants)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Transportation (see Ambulance)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Urgent Care (Not provided in an ER)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  In Area

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Out of Area

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Vision Care

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Implanted
  Lenses (post cataract)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Lenses & Frames Incident to cataract

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Non-Cataract
  Lenses and Frames

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  •                  Refractions
  (not medically related)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Vision Screening

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  Well Woman Examination

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  

 

This is intended only as a summary guide of
financial responsibility as stated on the contract.  It is not possible to list all medical services.  If you have any questions as to the
financial responsibility for a service not listed above Blue Shield follows
Medicare guidelines for all product lines. 
Services covered under Medicare Part A are Shared Savings Fund responsibility
and services covered under Medicare Part B are Medical Group responsibilities.

 

*** All
references to the division of financial responsibility have been deleted.

 

67

 

Exhibit B-l

HMO/IPA Medical Group Agreement

Division of Financial Responsibilities

NorthWest Orange County Medical Group - Anaheim

Effective Date: February 1, 2003

 

“Full Professional Service”
for the purposes of capitation is defined as all covered outpatient and
Inpatient professional health care services provided by a Physician or other
appropriate health care provider and all covered outpatient diagnostic and
treatment services, supplies, materials, drugs, and medicines, used or
administered in the office, or other outpatient setting, except the facility
charges for ambulatory surgery and in-area Emergency services.  Capitated Services include the following
specific services:

 

1.                                     HEALTH MAINTENANCE/PREVENTION

 

All
office visits for well baby care; periodic/routine screenings and examinations
for children, adolescents and adults; immunizations and injections, including
the cost of injectables, when provided as part of acceptable medical care;
vision and hearing exams for Members up to age 18, including:

 

a.                    preventive care - routine physical exams

 

b.                   eye/ear screenings up to age 18

 

c.                    therapeutic injections/injectables; provided
in MD office or Outpatient Setting (excluding all childhood immunizations first
recommended fo use by the American Academy of Pediatrics on or after 1-01-01
and Prevnar®)).  BSC-HMO covers all
childhood immunizations first recommended for use by the American Academy of
Pediatrics on or after 1-01-01 and Prevnar ®

 

d.                   therapeutic injections/injectables

 

e.                    health screening and monitoring - HMO Health
Incentive Program

 

2.                                      PATIENT COUNSELING/HEALTH EDUCATION

 

All
Member counseling and patient health education regarding personal health
behavior, health care and use of health care services; patient counseling for
family planning, family planning services and genetic counseling; when
indicated, all health education services and classes provided or sponsored by
IPA, or IPA Providers and, when indicated, referrals to other health education
services or classes and referral follow-up.

 

3.                                      OFFICE/OUTPATIENT MEDICAL AND SURGICAL
SERVICES

 

All
office visits and outpatient services provided by an IPA Provider for the
purpose of treatment of an illness or injury; and office visits and outpatient
services for the purpose of diagnosis and triage of a patient whose condition warrants
the care of an IPA Provider .  All
supplies, materials, orthotics/prosthetics under $50, drugs and medicines
administered in the office or other outpatient setting.

 

a.                    office medical services - diagnosis,
treatment, triage

 

b.                   consultations and second opinions

 

c.                    minor procedures - all minor procedures or
surgery performed in an office setting and professional services for facility
based ambulatory surgery

 

d.                   mental health - psychiatric/substance abuse
for commercial Members who fall under the requirements of California’s Assembly
Bill 88 (AB88) and whose benefits have not been renewed since 7-1-00 and for
commercial Members who do not fall under the requirements of AB88.

 

***
Confidential Treatment requested

 

68

 

Acute
detox for all members.  BSC-HMO covers
all professional and facility charges associated with psychiatric/substance
abuse services for commercial Members who fall under the requirements of AB88
and whose benefits renewed or became effective on or after 7-1-00.

 

e.                    outpatient physical rehabilitation - all
outpatient physical therapy, occupational therapy and speech therapy

 

f.                      outpatient radiation therapy, chemotherapy and
chemotherapy drugs, outpatient hemodialysis and other outpatient treatments and
therapies, including facility-based day care treatment

 

g.                   nutritional counseling by a nutritionist or
dietitian

 

h.                   medical social services

 

i.                       other health care professionals

 

4.                                       OFFICE/OUTPATIENT MEDICAL AND SURGICAL VISITS
- CHRONIC CARE

 

All
office visits and outpatient services provided by an IPA Provider for the
purpose of monitoring all chronic conditions. 
All supplies, materials, orthotics/prosthetics under $50, drugs and
medicines administered in the office or other outpatient setting.

 

5.                                       DIAGNOSTIC TESTS

 

All
outpatient diagnostic tests necessary for the provision of the services
outlined in items 1 - 4 above, including the technical and professional
services for laboratory, diagnostic x-ray, preadmission testing, nuclear medicine,
ultrasounds, CT and NMR scans, angiograms and other major diagnostic imaging,
electrodiagnostic services, pulmonary function and cardiac testing and other
outpatient diagnostic procedures.

 

6.                                       HOSPITAL/SNF MEDICAL CARE

 

Hospital/SNF
admissions; all Inpatient visits or other professional service by an IPA
Provider for the purpose of providing Inpatient medical or surgical care,
including the professional component for Inpatient radiology, pathology and
anesthesiology; determining and arranging for necessary Inpatient care provided
in a Hospital/SNF by an IPA Provider; monitoring care provided in a
Hospital/SNF by an IPA Provider; making appropriate discharge plans; and
Hospital/SNF discharges.

 

7.                                       HOME MEDICAL SERVICES

 

Home
or convalescent home visits when Medically Necessary; and determining,
arranging and monitoring home health care treatment plans provided by a Plan
Home Health Agency.

 

8.                                       IN-AREA URGENT/EMERGENCY MEDICAL SERVICES

 

a.                    Emergency triage on a 24-hour a day basis to
the most appropriate location for emergency treatment; and

 

b.                   telephone advice, as medically appropriate, on
a 24-hour a day basis for treatment of minor illnesses and injuries; and

 

c.                    all professional charges for in-area Emergency
services on a 24-hour a day basis, provided by a Hospital.  (The Plan covers the facility portion of
Service Area Emergency room services.)

 

69

 

9.                                       OUT-OF-AREA/OUT OF PLAN NON-EMERGENCY SERVICES

 

All services outlined in 1 - 7 above rendered
out-of-area or out of Plan, because needed services are not available within
the IPA, service area or Plan network. 
The Plan covers all professional and facility charges for out-of-area
Emergency services.

 

10.                                 CASE MANAGEMENT/HMO
ADMINISTRATION

 

All telephone consultations and coordination with,
and written correspondence to Plan personnel, IPA Providers and Hospitals
required for case management and the BSC-HMO quality and utilization management
program, as per this Agreement.

 

70

 

Exhibit C

HMO IPA/Medical Group Agreement

 

CAPITATION

 

NORTHWEST ORANGE COUNTY MEDICAL GROUP

 

Effective Date: FEBRUARY 1, 2003

 

CAPITATION PAYMENTS

 

Pursuant
to Article VII of the Agreement, Blue Shield shall pay to Group, based upon the
Member’s Benefit Program, the monthly per member per month (PMPM) Capitation
set forth in Exhibit C-l hereto. 
Capitation for non-Blue Shield 65 Plus Members is a specified dollar
rate based upon the Member’s benefit plan design, including copayment levels and
age/sex category.  Per Exhibit C-l, the
capitation rate for each member is a product of the Member’s age/sex category
multiplied by the corresponding base rate multiplied by the applicable co-pay
adjustment factor.  The sum of the
individual capitation rates for assigned Members will be added to determine the
Group’s aggregate Capitation payable for any given month.  Capitation for Blue Shield 65 Plus Members
is a percentage of the Medicare premium received by Blue Shield from CMS for
the basic medical benefits for such Members and excludes any premium paid by
CMS, the Member or an Employer Group for rider benefits that are not the
financial responsibility of Group.

 

Information
on actuarial cost and utilization assumptions, as required by Subchapter 5.5 of
Chapter 3 of Title 28, California Code of Regulations § 1300.75.4.1 (a) is
further described in the Provider Manual and is updated at least annually.  The information presented therein regarding
cost and utilization is provided by way of example only and is based broadly on
historical data in Blue Shield’s possession. 
It is not a statement of fact or opinion of what will actually occur and
is not offered as an accurate predictor of the experience of any specific
Group.  It is not intended to reflect the
actual cost or utilization incurred by any specific Group, does not predict the
actual costs to any specific group or patient mix, and has not been risk
adjusted in any way (capitation adjustments for age, sex and benefit plan
design are reflected in this Exhibit C.). 
Group recognizes that its actual utilization and unit costs will likely
differ from the examples given and could be higher or lower.  Group should not rely on this information in
evaluating its own financial risk, but, rather, should review its own patient
mix, utilization and cost information as well as other available information,
consult with its own financial and actuarial advisors in evaluating the
information contained herein, and make its own independent business judgment in
deciding to enter into the financial risk arrangements under the Agreement
based on its own independent assessment.

 

ENCOUNTER DATA SUBMISSION PENALTIES

In
the event that Group fails to comply with the encounter data submission
requirements described in Paragraph 2.12 hereof, then the amounts to be
deducted or withheld from Group’ Capitation on a monthly basis as provided in
Paragraph 7.11 hereof are identified in Exhibit C-l as “Penalties for Deficient
Encounter Data Submission”.

 

***

 

***
Confidential Treatment requested

 

71

 

Exhibit C-1

 

HMO IPA/Medical Group
Agreement

Capitation Rates for North
West Orange County Medical Group

Effective Date: 02/01/2003

 

As of 02/01/2003, the
effective net yield (which includes the deduction for Stop Loss, if applicable)
for the following PMPMs and factors are *** for the HMO Group. *** for HMO IFP.
*** for POS, *** for the PERS Group, and *** pmpm in aggregate, based on the
07/01/2002 membership.

 

The actual capitation
payment for each month will be calculated based on the actual member mix for
each age/sex/copay level category.

 

A.
Members Other Than Blue Shield 65 Plus

Members

 

Age & Sex Categories and Capitation Fees

 

	
   

  	
   

  	
   

  	
   

  	
  Benefit /
  Rate Adjustment

  	
   

  
	
  Category

  	
   

  	
  Age/Sex
  Adjusted Capitation (PMPM)

  	
   

  	
  Office Visit Copay Factor

  	
   

  
	
  Sex

  	
   

  	
  Age

  	
   

  	
  Group

  (non-POS)

  	
   

  	
  IFP

  (non-POS)

  	
   

  	
  POS

  (In-network)

  	
   

  	
  PERS

  (non-POS)

  	
   

  	
  Office
  Visit 

  Copay

  	
   

  	
  Factor

  	
   

  
	
  F

  	
   

  	
  0 -1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.081

  	
   

  
	
  F

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.071

  	
   

  
	
  F

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.061

  	
   

  
	
  F

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.052

  	
   

  
	
  F

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.043

  	
   

  
	
  F

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.034

  	
   

  
	
  F

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.026

  	
   

  
	
  F

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.017

  	
   

  
	
  F

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.009

  	
   

  
	
  F

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.001

  	
   

  
	
  F

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.994

  	
   

  
	
  F

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.986

  	
   

  
	
  F

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.979

  	
   

  
	
  F

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.972

  	
   

  
	
  F

  	
   

  	
  65 + (M)*

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.965

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.958

  	
   

  
	
  M

  	
   

  	
  0 - 1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.951

  	
   

  
	
  M

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.944

  	
   

  
	
  M

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.937

  	
   

  
	
  M

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.930

  	
   

  
	
  M

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.923

  	
   

  
	
  M

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.917

  	
   

  
	
  M

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.910

  	
   

  
	
  M

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.903

  	
   

  
	
  M

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.897

  	
   

  
	
  M

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.890

  	
   

  
	
  M

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.858

  	
   

  
	
  M

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.825

  	
   

  
	
  M

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.793

  	
   

  
	
  M

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.760

  	
   

  
	
  M

  	
   

  	
  65 + (M)*

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.728

  	
   

  

 

* = Medicare Primary

 

*** All references to the capitation
rates have been deleted.

 

72

 

The preceding capitation
rates do not apply to Members enrolled through the Healthy Families
Program.  For Healthy Family Program
Members, the following capitation rates shall apply:

 

	
  Age 0 – 11.99 months

  	
   

  	
  $

  	
  NA

  	
   

  	
  PMPM

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Age 1 year – 18 years 11.99 mos.

  	
   

  	
  $

  	
  NA

  	
   

  	
  PMPM

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Age 19 – years – 44 years 11.99 mos.

  	
   

  	
  $

  	
  NA

  	
   

  	
  PMPM

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Age 45 years +

  	
   

  	
  $

  	
  NA

  	
   

  	
  PMPM

  	
   

  

 

B.           Blue Shield 65 Plus Members
– Basic Capitation

NA percent (NA%) of the Monthly CMS
Capitation received by Blue Shield from CMS and the equivalent percentage of
the actual Monthly Blue Shield 65 Plus Premium (as described below) which Blue
Shield determines, according to its actuarial standards and methodology, to be
for a benefit that is included in the Member’s basic benefit plan and for which
Group bears financial risk.  Blue Shield
will retain 100% of premiums collected for benefits considered supplemental to
the basic benefit plan (as described below). 
Blue Shield may make monthly retroactive adjustments to reflect any
retroactive adjustments made by CMS to the Monthly CMS Capitation.

 

The
“Monthly CMS Capitation” refers to the monthly premium payment made by CMS to
Blue Shield as payment to Blue Shield for the provision of services to the Blue
Shield 65 Plus Members enrolled in Blue Shield.

 

The
“Monthly Blue Shield 65 Plus Premium Payments” refers those additional premium
payments which Blue Shield receives directly from the member or from the
employer group for basic benefit plan provisions.

 

“Supplemental
Benefits” are benefits offered to enhance the basic benefit provided by Blue
Shield in the Member’s county of residence. 
Additional premiums (beyond the base plan premium, if applicable) are
collected from Members and employer groups for such benefits.  Group shall have no financial responsibility
for the administration and/or delivery of such benefits.

 

C.            PENALTIES FOR DEFICIENT ENCOUNTER DATA SUBMISSION  If
minimum submission requirements are not met, as defined in the Provider Manual,
and are not corrected within a thirty (30) day notice period, Group shall be
subject to a penalty of three percent (3%) of the Group’s commercial capitation
payment and, if applicable, NA percent (NA%) of the Group’s Blue Shield
65 Plus capitation payment for the period(s) in question from the monthly
capitation payments until the deficiency is corrected.

 

***

 

73

 

EXHIBIT C-1.1

 

HMO IPA/Medical Group Agreement

Capitation Rates for NorthWest Orange County Medical Group

Effective Date: 02/01/2004

 

As of 02/01/2004, the effective net yield (which includes
the deduction for Stop Loss, if applicable) for the following PMPMs and factors
are *** for the HMO Group, *** for HMO IFP, *** for POS, *** for the PERS
Group, and *** pmpm in aggregate, based on the 07/01/2002 membership.

 

The actual capitation payment
for each month will be calculated based on the actual member mix for each
age/sex/copay level category.

 

A. Members Other Than Blue Shield 65 Plus

Members

 

Age & Sex
Categories and Capitation Fees

 

	
   

  	
   

  	
   

  	
   

  	
  Benefit /
  Rate Adjustment

  	
   

  
	
  Category

  	
   

  	
  Age/Sex
  Adjusted Capitation (PMPM)

  	
   

  	
  Office Visit Copay Factor

  	
   

  
	
  Sex

  	
   

  	
  Age

  	
   

  	
  Group

  (non-POS)

  	
   

  	
  IFP

  (non-POS)

  	
   

  	
  POS

  (In-network)

  	
   

  	
  PERS

  (non-POS)

  	
   

  	
  Office
  Visit

  Copay

  	
   

  	
  Factor

  	
   

  
	
  F

  	
   

  	
  0 - 1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.081

  	
   

  
	
  F

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.071

  	
   

  
	
  F

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.061

  	
   

  
	
  F

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.052

  	
   

  
	
  F

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.043

  	
   

  
	
  F

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.034

  	
   

  
	
  F

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.026

  	
   

  
	
  F

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.017

  	
   

  
	
  F

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.009

  	
   

  
	
  F

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.001

  	
   

  
	
  F

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.994

  	
   

  
	
  F

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.986

  	
   

  
	
  F

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.979

  	
   

  
	
  F

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.972

  	
   

  
	
  F

  	
   

  	
  65 + (M) *

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.965

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.958

  	
   

  
	
  M

  	
   

  	
  0 - 1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.951

  	
   

  
	
  M

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.944

  	
   

  
	
  M

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.937

  	
   

  
	
  M

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.930

  	
   

  
	
  M

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.923

  	
   

  
	
  M

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.917

  	
   

  
	
  M

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.910

  	
   

  
	
  M

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.903

  	
   

  
	
  M

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.897

  	
   

  
	
  M

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.890

  	
   

  
	
  M

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.858

  	
   

  
	
  M

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.825

  	
   

  
	
  M

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.793

  	
   

  
	
  M

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.760

  	
   

  
	
  M

  	
   

  	
  65 + (M) *

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.728

  	
   

  

 

* = Medicare Primary

 

*** All
references to the capitation rates have been deleted.

 

74

 

The preceding capitation rates do not apply to Members enrolled through
the Healthy Families Program. For Healthy Family Program Members, the following
capitation rates shall apply:

 

	
  Age 0 – 11.99 months

  	
   

  	
  $

  	
  NA

  	
   

  	
  PMPM

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Age 1 year – 18 years 11.99 mos.

  	
   

  	
  $

  	
  NA

  	
   

  	
  PMPM

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Age 19 – years – 44 years 11.99 mos.

  	
   

  	
  $

  	
  NA

  	
   

  	
  PMPM

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Age 45 years +

  	
   

  	
  $

  	
  NA

  	
   

  	
  PMPM

  	
   

  

 

B.       Blue Shield 65 Plus Members
- Basic Capitation

NA percent (NA%) of the Monthly CMS
Capitation received by Blue Shield from CMS and the equivalent percentage of
the actual Monthly Blue Shield 65 Plus Premium (as described below) which Blue
Shield determines, according to its actuarial standards and methodology, to be
for a benefit that is included in the Member’s basic benefit plan and for which
Group bears financial risk.  Blue Shield
will retain 100% of premiums collected for benefits considered supplemental to
the basic benefit plan (as described below). 
Blue Shield may make monthly retroactive adjustments to reflect any
retroactive adjustments made by CMS to the Monthly CMS Capitation.

 

The
“Monthly CMS Capitation” refers to the monthly premium payment made by CMS to
Blue Shield as payment to Blue Shield for the provision of services to the Blue
Shield 65 Plus Members enrolled in Blue Shield.

 

The
“Monthly Blue Shield 65 Plus Premium Payments” refers those additional premium
payments which Blue Shield receives directly from the member or from the
employer group for basic benefit plan provisions.

 

“Supplemental
Benefits” are benefits offered to enhance the basic benefit provided by Blue
Shield in the Member’s county of residence. 
Additional premiums (beyond the base plan premium, if applicable) are
collected from Members and employer groups for such benefits.  Group shall have no financial responsibility
for the administration and/or delivery of such benefits.

 

C.       PENALTIES FOR DEFICIENT
ENCOUNTER DATA SUBMISSION If
minimum submission requirements are not met, as defined in the Provider Manual,
and are not corrected within a thirty (30) day notice period, Group shall be
subject to a penalty of three percent (3%) of the Group’s commercial capitation
payment and, if applicable, NA percent (NA) of the Group’s Blue Shield
65 Plus capitation payment for the period(s) in question from the monthly
capitation payments until the deficiency is corrected.

 

***

 

75

 

Exhibit D

 

HMO IPA/Medical Group Agreement

 

SHARED SAVINGS PROGRAMS

 

NORTHWEST ORANGE COUNTY MEDICAL GROUP

 

EFFECTIVE DATE: FEBRUARY 1, 2003

 

A.                                    COMMERCIAL MEMBERS

 

FUNDING: For Members other
than those enrolled in Blue Shield 65 Plus plans and Blue Shield POS Benefit
Programs, Blue Shield will allocate to a Shared Savings Fund a per Member per
month amount set forth in Exhibit D-l for all Members assigned to Group,
subject to retroactive adjustments either upward or downward due to retroactive
changes in membership.  [See Exhibit G-2
for provisions relating to Blue Shield POS Benefit Programs and POS Shared
Savings Funds.] If the overall hospital per diem rates, including La Palma
Intercommunity Hospital and West Anaheim Medical Center, increase more than
7.00% in 2004.  Blue Shield will meet
with Group to review the funding of the Shared Savings Program.

 

CHARGING
OF PAYMENTS: Blue Shield shall charge against the Shared Savings Fund all
payments made by Blue Shield for such Members during the annual term of the
Agreement which are designated as Shared Savings Services in Exhibit B, less
payments received by Blue Shield as a result of third-party reimbursement,
Workers’ Compensation recoveries and coordination of benefits payments.  Blue Shield shall include any payments for
Shared Savings Services which are paid prior to the date of the settlement, as
well as a reasonable allowance, as determined by Blue Shield’s actuaries, for
incurred but not paid (IBNP) claims. 
Any costs for Shared Savings Services not included in any annual
settlement shall be carried forward and included in the Shared Savings
settlement for the succeeding Agreement Year. 
In addition, if this Agreement is replaced or superceded any other
agreement between the parties which contained a risk sharing arrangement for
similar services; then the following shall also be charged against the Shared
Savings Fund described herein: ( i ) any deficit in the final settlement of
that risk sharing arrangement and, (ii) any claims for risk services which were
incurred but not included in the settlement of the risk arrangement in the
prior agreement.

 

SHARED
SAVINGS FUND SETTLEMENT: The Shared Savings Fund shall be settled on an annual
basis, within one hundred eighty (180) days following the end of each annual
term of the Agreement (being a 120 day claims run out and a 60 day
determination period).  In the event of
termination of the Agreement for any reason, final settlement of the Shared
Savings Fund shall be performed one hundred fifty (150) days after the date of
termination and any amounts due from Blue Shield to Group shall be paid within
thirty (30) days thereafter.

 

Surplus:  If
the total actual cost of Shared Savings Services is less than the total
allocation to the Shared Savings Fund, then Group shall be entitled to fifty
percent (50%) of the amount by which the allocation exceeds the costs.

 

***
Confidential Treatment requested

 

76

 

not
to exceed thirty-five percent (35%) of HMO Capitation Fees, minus any carry
forward resulting from deficits from previous Agreement years.

 

Deficit:  If
the total actual cost of Shared Savings services is more than the total
allocation to the Shared Savings Fund, then fifty percent (50%) of the amount
by which the actual costs exceed the total allocation, not to exceed five
percent (5%) of the HMO Capitation Fees, shall be allocated to Group and shall
be handled as follows: (i) the excess may be deducted from any other
settlements or payments, except capitation and Professional Stop Loss Program
payments made pursuant to Exhibit H, due to Group from Blue Shield, and, (ii)
any remaining amounts shall be carried forward into future Agreement years and
shall be deducted from any Shared Savings payments to Group in future years.

 

SUMMARIES
& SETTLEMENTS: Blue Shield shall provide to Group a Shared Savings Program
quarterly Report and a Shared Savings Annual Settlement, as further described
in the Provider Manual.

 

B.                                   BLUE SHIELD 65 PLUS MEMBERS

 

FUNDING: For Members
enrolled in Blue Shield 65 Plus plans, Blue Shield will allocate to a Shared
Savings Fund a per Member per month percentage amount set forth in Exhibit D-2
for all Members assigned to Group, subject to retroactive adjustments either
upward or downward due to retroactive changes in membership.

 

CHARGING
OF PAYMENTS: Blue Shield shall charge against the Shared Savings Fund all
payments made by Blue Shield for such Members during the annual term of the
Agreement which are designated as Shared Savings Services in Exhibit B, less
payments received by Blue Shield as a result of third-party reimbursement,
Workers’ Compensation recoveries and coordination of benefits payments.  Blue Shield shall include any payments for
Shared Savings Services which are paid prior to the date of the settlement, as
well as a reasonable allowance, as determined by Blue Shield’s actuaries, for
incurred but not paid (IBNP) claims. 
Any costs for Shared Savings Services not included in any annual
settlement shall be carried forward and included in the Shared Savings
settlement for the succeeding Agreement Year. 
In addition, if this Agreement is replaced or superceded any other
agreement between the parties which contained a risk sharing arrangement for
similar services; then the following shall also be charged against the Shared
Savings Fund described herein: (i) any deficit in the final settlement of that
risk sharing arrangement and, (ii) any claims for risk services which were
incurred but not included in the settlement of the risk arrangement in the
prior agreement.

 

SHARED
SAVINGS FUND SETTLEMENT: The Shared Savings Fund shall be settled on an annual
basis, within one hundred eighty (180) days following the end of each annual
term of the Agreement (being a 120 day claims run out and a 60 day
determination period).  In the event of
termination of the Agreement for any reason, final settlement of the Shared
Savings Fund shall be performed one hundred fifty (150) days after the date of
termination and any amounts due from Blue Shield to Group shall be paid within
thirty (30) days thereafter.

 

77

 

Surplus:  If
the total actual cost of Shared Savings Services is less than the total
allocation to the Shared Savings Fund, then Group shall be entitled to NA
percent (NA) of the amount by which the allocation exceeds the costs, minus any
carry forward resulting from deficits from previous Agreement years.

 

Deficit:  If
the total actual cost of Shared Savings Services is more than the total
allocation to the Shared Savings Fund, then NA percent (NA) of the
amount by which the actual costs exceed the total allocation shall be allocated
to Group and shall be handled as follows: (i) the excess may be deducted from
any other settlements or payments, except capitation and Professional Stop Loss
Program payments made pursuant to Exhibit I, due to Group from Blue Shield,
and, (ii) any remaining amounts shall be carried forward into future Agreement
years and shall be deducted from any Shared Savings payments to Group in future
years.

 

SUMMARIES & SETTLEMENTS:
Blue Shield shall provide to Group a Shared Savings Program Quarterly Report
and a Shared Savings Annual Settlement, as further described in the Provider
Manual.

 

C.                                    PHARMACY SHARED SAVINGS FUND

 

FUNDING: For Members
enrolled in Blue Shield 65 Plus, Blue Shield will allocate to a separately
administered Pharmacy Shared Savings Fund a per member per month percentage
amount as set forth in Exhibit D-3 for all Members assigned to Group.  All membership is subject to retroactive
adjustments either upward or downward due to retroactive changes in membership.

 

CHARGING
OF PAYMENTS: Blue Shield will charge against the Pharmacy Shared Savings Fund
the actual cost paid by Blue Shield for outpatient prescription drug services
provided to assigned members, as well as a reasonable allowance, as determined
by Blue Shield’s actuaries, for incurred but not paid (IBNP) outpatient
prescription drug claims.  Pharmacy
costs include the ingredient cost for Covered Services rendered to Members for
which the Pharmacy Shared Savings Fund is financially responsible per Exhibit
B, professional dispensing fees paid to participating pharmacies, less
associated pharmacy co-payment revenue. 
Any costs for outpatient prescription drug services not included in any
annual settlement shall be carried forward and included in the Pharmacy Risk
Fund settlement for the succeeding Agreement Year.  In addition, if this Agreement is replaced or superceded any
other agreement between the parties which contained a risk sharing arrangement
for similar services; then the following shall also be charged against the
Shared Savings Fund described herein: (I) any deficit in the final settlement
of that risk sharing arrangement and, (ii) any claims for risk services which
were incurred but not included in the settlement of the risk arrangement in the
prior agreement.

 

PHARMACY
RISK FUND SETTLEMENT: The Pharmacy Shared Savings Fund shall be settled on an
annual basis, within one hundred eighty (180) days following the end of each

 

78

 

annual term of the Agreement
(being a 120 day claims run out and a 60 day determination period).  In the event of termination of the Agreement
for any reason, final settlement of the Pharmacy Risk Fund shall be performed
one hundred fifty (150) days after the date of termination and any amounts due
from Blue Shield to Group shall be paid within thirty (30) days thereafter.

 

Surplus:  If
the total actual cost of outpatient prescription drugs is less than the total
allocation to the Pharmacy Risk Fund, then Group shall be entitled to NA percent
(NA) of the amount by which the allocation exceeds the costs, minus any carry
forward resulting from deficits from previous Agreement years.

 

Deficit:  If
the total actual cost of Pharmacy Shared Savings services is more than the
total allocation to the Pharmacy Shared Savings Fund, then NA percent
(NA) of the amount by which the actual costs exceed the total allocation shall
be allocated to Group and shall be handled as follows: (i) the excess may be
deducted from any other settlements or payments, except capitation and
Professional Stop Loss Program payments made pursuant to Exhibit I, due to
Group from Blue Shield, and, (ii) any remaining amounts shall be carried
forward into future Agreement years and shall be deducted from Pharmacy Shared
Savings Payments to Group in future years.

 

SUMMARIES & SETTLEMENTS:
Blue Shield shall provide to Group, as further described in the Provider
Manual, on a quarterly basis, a summary of the Pharmacy Shared savings expenses
along with a comparison to the Pharmacy Shared Savings Funding and utilization
data pertaining to the cost of prescriptions written on a physician specific
basis.  Blue Shield shall also provide
to Group a Shared Savings Annual Settlement.

 

79

 

Exhibit
D-1

 

HMO IPA/Medical Group Agreement

Shared Savings Fund Allocation for NorthWest
Orange County Medical Group

Effective Date: 02/01/03

 

As
of 02/01/2003, the effective net yield (which includes the deduction for Stop
Loss, if applicable) for the following PMPMs are *** for the HMO Group *** for
the HMO IFP, and *** for the HMO PERS based on the 07/01/2002 membership.

 

The actual allocation to Shared Saving Fund
for each month will be calculated based on the actual member mix for each
age/sex category.

 

Members Other Than Blue Shield 65 Plus
Members

 

Age & Sex Categories and Shared Savings
Allocations

 

	
  Category

  	
   

  	
  Shared
  Savings Allocation (PMPM)

  	
   

  
	
  Sex

  	
   

  	
  Age

  	
   

  	
  Group

  (non-POS)

  	
   

  	
  IFP

  (non-POS)

  	
   

  	
  PERS

  (non-POS)

  	
   

  
	
  F

  	
   

  	
  0 - 1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  65 + (M)*

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  0 - 1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  65 + (M)*

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  

 

* = Medicare Primary

 

*** All
references to the shared savings fund allocation have been deleteted.

 

80

 

Exhibit D-1.1

 

HMO IPA/Medical Group Agreement

Shared Savings Fund Allocation for NorthWest Orange County Medical
Group

Effective Date: 02-01-04

 

 

As of 02/01/2004, the effective net yield (which includes
the deduction for Stop Loss, if applicable) for the following PMPMs are *** for
the HMO Group, *** for the HMO IFP, and *** for the HMO PERS based on the
07/01/2002 membership.

 

The actual allocation to Shared Saving Fund for each month will be
calculated based on the actual member mix for each age/sex category.

 

Members Other
Than Blue Shield 65 Plus Members

 

Age & Sex
Categories and Shared Savings Allocations

 

	
  Category

  	
   

  	
  Shared
  Savings Allocation (PMPM)

  	
   

  
	
  Sex

  	
   

  	
  Age

  	
   

  	
  Group

  (non-POS)

  	
   

  	
  IFP

  (non-POS)

  	
   

  	
  PERS

  (non-POS)

  	
   

  
	
  F

  	
   

  	
  0 - 1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  F

  	
   

  	
  65 + (M)*

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  0 - 1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  M

  	
   

  	
  65 + (M)*

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  

 

* = Medicare Primary

 

*** All
references to the shared savings fund allocation have been deleteted.

 

81

 

EXHIBIT D-2

 

HMO IPA/Medical Group Agreement

 

SHARED SAVINGS FUND ALLOCATIONS

 

NORTHWEST ORANGE COUNTY MEDICAL GROUP

 

EFFECTIVE DATE: FEBRUARY 1, 2003

 

 

BLUE SHIELD 65 PLUS MEMBERS

 

NA percent (NA %) of the Monthly CMS
Capitation received by Blue Shield from CMS and NA percent ( NA %)
of the monthly premium received by Blue Shield from the Member or from an
Employer Group which Blue Shield determines, according to its actuarial
standards and methodology, to be for a benefit that is designated as a Shared
Savings Service in Exhibit B.

 

***
Confidential Treatment requested

 

82

 

Exhibit D-3

 

HMO IPA/Medical Group Agreement

 

PHARMACY SHARED SAVINGS FUND ALLOCATIONS

 

NORTHWEST ORANGE COUNTY MEDICAL GROUP

 

Effective Date:  
NA

 

BLUE SHIELD 65 PLUS MEMBERS

 

NA percent
(NA%) of the Monthly CMS Capitation received by Blue Shield from CMS and
NA percent (NA%) of the monthly premium received by Blue Shield from the
Member or from an Employer Group which Blue Shield determines, according to
its actuarial standards and methodology, to be for outpatient prescription drug
services.

 

***
Confidential Treatment requested

 

83

 

Exhibit E

 

HMO IPA/Medical Group Agreement

 

BLUE SHIELD ALLOWABLE RATES

 

NORTHWEST ORANGE COUNTY MEDICAL GROUP

 

Effective Date:  
February 1, 2003

 

The following shall
constitute Blue Shield Allowable Rates to be paid to Group or Group Providers
for Reciprocity (Paragraph 2.10), Retroactive Deletions (Paragraph 6.3(b)), and
Services Other Than Capitated Professional Services (Paragraph 7.2):

 

The
lesser of one hundred percent (100%) of the Blue Shield PPO Physician
Allowances in effect on the date of service, or the amount paid by the Group
(or Group Provider) for the services, if any, (excluding Capitation payment),
minus the Member’s/individual’s applicable copayment, coinsurance or deductible.  Further detail regarding Blue Shield’s
proprietary fee schedule is provided upon request.

 

 

***

 

84

 

Exhibit F

 

HMO IPA/Medical Group Agreement

 

DELEGATION RESPONSIBILITIES

 

NORTHWEST ORANGE COUNTY MEDICAL GROUP

 

Effective Date:  
February 1, 2003

 

1.                                       Delegation Responsibilities & Penalties.  The
capitation amounts paid to Group by Blue Shield as set forth in Paragraph 7.1
(a) of this Agreement are based on Blue Shield’s expectation that the Group
accepts and will perform delegation of the requirements set forth as Group’s
responsibility in Attachments I, II, III and IV of this Exhibit F. The quality
improvement and quality management obligations of Blue Shield are not delegated
to Group; however, Group shall have its own fully functional Quality Management
Program, as described in Attachment 1, that is cooperative with and integrated
into the Blue Shield Quality Management Program. In accordance with paragraph
4.3 (c) of this Agreement, the net monthly capitation penalty reduction for any
de-delegated function shall be as follows:

 

	
   

  	
   

  	
  Commercial

  	
   

  	
  Blue
  Shield 65 plus

  	
   

  
	
  UM/Professional

  	
   

  	
  2.5

  	
  %

  	
  3.0

  	
  %

  
	
  UM/Shared Savings

  	
   

  	
  2.5

  	
  %

  	
  3.0

  	
  %

  
	
  Credentialing

  	
   

  	
  .5

  	
  %

  	
  .5

  	
  %

  
	
  Claims Processing

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Non contracted only penalty

  	
   

  	
  .7

  	
  %

  	
  .7

  	
  %

  
	
  All Claims penalty

  	
   

  	
  6.5

  	
  %

  	
  7.0

  	
  %

  
	
  Non contracted only payment withhold*

  	
   

  	
  8.0

  	
  %

  	
  8.5

  	
  %

  
	
  All Claims payment withhold*

  	
   

  	
  85.0

  	
  %

  	
  85.0

  	
  %

  

 

*Subject to actual claims
paid experience.

 

Dedelegation
penalties for Claims Processing do not apply in cases where Blue Shield
participates in joint administration of claims processing on Group’s premises,
however, Group shall reimburse Blue Shield for Blue Shield’s cost of providing
on site assistance and shall provide workstations and equipment as required.

 

2.                                       Delegation Criteria and Standards. Blue Shield has developed and adopted
delegation criteria and standards for performance of delegated activities for
the delegation of utilization management, medical records audits,
credentialing, professional site reviews, and claims processing.  These criteria and standards as set forth in
the Provider Manual and this Exhibit F, may be modified from time to time by
Blue Shield.  Group warrants to Blue
Shield that it meets the criteria for the activities, and is willing to, and
capable of, performing such delegated activities in full compliance with the
standards.  Group shall promptly notify
Blue Shield in

 

85

 

writing,
within no less than seven (7) business days, in the event it ceases, in whole
or in part, to meet such criteria.

 

3.                                       Blue Shield Monitoring and Oversight.  Blue
Shield shall be entitled to conduct audits of Group’s compliance with the
criteria and standards.  Upon advance
notice by Blue Shield, Group shall provide reasonable access during regular
business hours to its claims, claims supporting documentation, Member inquiry
files, credentialing files, clinical and medical records of Members as
applicable and reasonably necessary to evaluate Group’s performance of its
delegated activities.  In the event
Group has insufficient data and records relating to Members to permit Blue
Shield to evaluate a particular activity under review, then Group shall provide
sufficient documents and information on non-Members, with all non-Member
identifying information deleted to preserve the confidentiality of such
information, in order to permit Blue Shield to evaluate Group’s performance of
such activity.  Group shall participate
in an annual evaluation and quarterly meetings between Blue Shield and Group
staff.  In addition, Group shall provide
to Blue Shield periodic reports on delegated activities as set forth in the
Provider Manual.  Group shall take such
corrective actions as requested by Blue Shield through the audit review process
within such time lines as established by Blue Shield.

 

4.                                       Shared Savings Service Authorization/Medical
Policy.  When
authorization responsibility for Shared Savings Services is delegated to Group,
Group shall pre-authorize Shared Savings Services (or, as appropriate,
retroactively authorize Emergency Services) and shall provide a copy of such
authorization to Blue Shield within seven (7) days following the
authorization.  Group shall provide to
Blue Shield weekly reports setting forth authorizations granted and denied, as
set forth in the Provider Manual.  All
utilization management and authorizations of Group shall be consistent with
Blue Shield’s Medical Policy.

 

5.                                       Blue Shield Request for Records, Files and
Reports Related to Delegated Credentialing and Recredentialing. Blue Shield shall be entitled to conduct
audits of Group’s compliance with the criteria and standards of Delegated
Credentialing and Recredentialing.  Upon
advance notice by Blue Shield, Group shall provide reasonable access during regular
business hours to credentialing files, as reasonably necessary to evaluate
Group’s performance of it’s delegated activities.  Group shall submit copies of credentialing/recredentialing files
for review by governmental, accrediting and regulatory review agencies.  Submission of documents by Group will be
within the required timeframe of the requesting agency.  Group shall participate in an annual
evaluation and quarterly meetings between Blue Shield and Group staff.  In addition, Group shall provide to Blue
Shield periodic reports on delegated activities as set forth in the Provider
Manual.  Group shall take such
corrective actions as requested by Blue Shield through the audit review process
within such time lines as established by Blue Shield.

 

86

 

ATTACHMENT I TO EXHIBIT F

 

BLUE SHIELD OF CALIFORNIA

QUALITY MANAGEMENT (QM) REQUIREMENTS*

 

	
  Ql Standard per BSC

  	
   

  	
  Activities
  Performed by Group

  	
   

  	
  Group
  Reporting

  Frequency to BSC

  	
   

  	
  BSC
  Oversight

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1.               Program Structure

  	
   

  	
  •                  Written QM Program

  •                  QM Program accountable to Governing
  Body.

  •                  Program evaluated annually and
  updated.

  •                  Designated physician has substantial
  involvement.

  •                  QM committee meets quarterty, at a
  minimum.

  •                  Annual QM work plan.

  •                  Annual QM evaluation.

  	
   

  	
  •                  Submit QM Program annually

  •                  Submit workplan annually.

  •                  Submit program evaluation annually.

  	
   

  	
  1.               Review and
  approval of:

  •                  Program

  •                  Work plan

  •                  Annual evaluation

  •                  QI Policies

  •                  QI Procedures

  •                  Clinical
  Guidelines

  •                  Access Guidelines

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2.                Program
  Operations

  	
   

  	
  •                  Provider QI Committee recommends policy
  decisions, reviews QI activities, institutes needed actions and ensures
  follow- up.

  •                  Contemporaneous, signed and dated
  minutes.

  •                  Physicians actively participate in QI
  program.

  •                  QI program coordinates monitoring
  activity throughout organization

   

  	
   

  	
  •                  Group policies and procedures
  related to QI submitted annually and any updates and changes submitted
  quarterly.

  •                  Annual Report to include monitoring activities and
  results, and improvements

   

  	
   

  	
  •                  Annual on-site assessment to include review of
  minutes

  •                  Annual review of monitoring reported to BSC’s
  QI/UM Committee.

   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  3.               Health Services
  Contracts

  	
   

  	
  •                  Negotiate contracts with subcontractors if
  written prior approval obtained from BSC.

  •                  Include in contract w/subcontracted
  vendors the requirement that the subcontracted vendor is obligated to
  participate in and be compliant with the BSC QI process and findings.

   

  	
   

  	
   

  	
   

  	
  Prospective
  review and approval of BSC contract for appropriate contract language

   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  4.               Availability of
  Primary Care Practitioners

  	
   

  	
  •                  Access studies

  •                  Keep BSC aware of closed PCP practices.

  •                  Keep BSC aware of changes in status
  of contracted providers

   

  	
   

  	
   

  	
   

  	
  •                  Review of open/closed panels

  •                  Monitoring of patient geographic access
  to PCP and specialists offices

  •                  Monitoring of appropriate referrals to
  out-of-network providers

  •                  Review of patient complaint trends re: access
  and availability to care and services.

  •                  Review of results of access studies

   

  

 

*Quality
Management is not a delegatable function and therefore not subject to
de-delegation.

 

87

 

	
  Ql Standard per BSC

  	
   

  	
  Activities
  Performed by Group

  	
   

  	
  Group
  Reporting

  Frequency to BSC

  	
   

  	
  BSC
  Oversight

  
	
  5.               Accessibility of
  Services - BSC is Responsible for Establishing access Guidelines for:

  •                            Wait times

  •                            Appointments

  •                            After-hours care

  •                            Telephone access;

  •                            Access for
  referrals to specialty care

  •                            Development of access study
  design, methodology and tools

   

  	
   

  	
  •                  Participate in BSC’s access surveys 

  •                  Schedule member
  appointments based on access guidelines.

  •                  Perform internal
  IPA/MG access study.

   

  	
   

  	
  •                  Quarterly access study results as performed by IPA/MG

   

  	
   

  	
  •                  Access Study Data results

  •                  Review Group’s Access Guidelines

  •                  Review of access-related patient
  complaints 

  •                  Trend reports of
  member complaints re: access

   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  6.               Member
  Satisfaction

  	
   

  	
  Participate
  in Group’s Member Satisfaction Surveys.

  	
   

  	
  Quarterly

  	
   

  	
  •                  Review of member complaint data.

  •                  Review of member survey data.

  •                  Review of BSC’s
  disenrollment for quality of care issues data.

   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  7.               Health Management
  Systems – BSC Designs population based
  programs to identify and manage chronic conditions of BSC members.

   

  	
   

  	
  •                  Data collection

  •                  Program Implementation as provided by
  BSC

  •                  Provider & staff education as provided by
  BSC

   

  	
   

  	
  •                  Annual submission of program design.

  •                  Annual submission of BSC member participation
  list.

   

  	
   

  	
  •                  Review by BSC of all provider- based chronic
  care initiatives.

  •                  Reconciliation of member participation
  list against BSC list of members assigned to Group with those chronic
  conditions being addressed, to ensure identification of all potentially
  eligible members.

  •                  Verification with individual providers of
  participation in the chronic care initiatives.

   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  8.               Clinical Practice
  Guidelines

  •                  acute and chronic
  services.

   

  	
   

  	
  •                  Adopts BSC guidelines

  •                  Disseminates guidelines to providers.

  •                  Measures performance against no less
  than 2 high-volume, high-risk problem-prone guidelines annually.

  •                  Submits for review to BSC individually
  developed guidelines and/or chosen industry established guidelines for
  review.

   

  	
   

  	
  •                  Annual submission of guidelines.

  •                  Submission of results of review of performance
  measurement against guide- lines to be included in the annual report.

   

  	
   

  	
  •                  BSC annual assessment to include process
  of guideline development, performance measurement, and distribution.

  •                  BSC to review and approve all guidelines.

   

  

 

*Quality
Management is not a delegatable function and therefore not subject to
de-delegation.

 

88

 

	
  Ql Standard per BSC

  	
   

  	
  Activities
  Performed by Group

  	
   

  	
  Group
  Reporting

  Frequency to BSC

  	
   

  	
  BSC
  Oversight

  
	
  9.               Scope and Content
  of non-preventive
  clinical QI issues: BSC identifies meaningful clinical issues for plan-wide monitoringand review.
  

   

  	
   

  	
  •                  Adopts BSC guidelines.

  •                  Educates group providers in the
  application and use of the BSC established processes.  

   

  	
   

  	
  •                  Annual submission of guidelines.

  •                  Submission ofresults
  of review of performance measurement against guide-lines to beincluded in
  the annual
  report.  

   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  10.         Clinical Measurement Activities:
  

   

  •                  Data collection  

  •                  Measurement  

  •                  Data analysis  

  •                  Intervention & Implementation
  

   

  Related to:  

  •                  Primary care services  

  •                  High-volume specialty services  

  •                  Behavioral Health services  

  •                  Institutional services  

  •                  Over/under utilization monitoring
  

  •                  Issues that affect continuity andcoordination
  of care and service.

  	
   

  	
  •                  Identify Group key clinical areas for studydevelopment

  •                  Data collection  

  •                  Data analysis  

  •                  Recommend and develop interventions
  

   

  	
   

  	
  •                  Prior to study implementation
  

  •                  On-going reports during implementation of study  

  •                  Clinical activity findings reported
  no less than quarterly  

   

  	
   

  	
  •                  Prospective review and approval of clinical
  measurement activities  

  •                  Quarterly review of monitoring activity results
  

   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  11.         Intervention
  & follow-up for clinical issues  

   

  	
   

  	
  •                  Implementation of action plan to immediate
  care and service.

  •                  Evaluate affects of actions taken.  

   

  	
   

  	
  •                  Prior to study implementation.
  

  •                  On-going reports during implementation of
  study.  

  •                  Clinical activity findings reported noless thanquarterly

  	
   

  	
  •                  Prospective review and approval of clinical
  measurement activities

  •                  Quarterly review of monitoring activity results
  

   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  12.         Effectiveness of
  QI Program
  and Demonstration of Required Improvements  

   

  	
   

  	
  •                  Group to participate in QI program by
  submission of required data. Group responsible for maintaining separate QI
  program for group function and issues

  	
   

  	
  •                  Annual QI program eval.

  •                  QI meeting minutes  

  •                  QI quarterly reporting on activities listed in QI Plan
  

   

  	
   

  	
  •                  Submission of QI annual evaluation.
  

   

  

 

*
Quality Management is not a delegatable function and therefore not subject to
de-delegation.

 

89

 

	
  Ql Standard per BSC

  	
   

  	
  Activities
  Performed by Group

  	
   

  	
  Group
  Reporting

  Frequency to BSC

  	
   

  	
  BSC
  Oversight

  
	
  13.         Grievance process/ Complaint handling &
  reporting 

  	
   

  	
  Group
  to coordinate with BSC for communication and management of Grievance and
  Appeals resolution.  

  	
   

  	
   

  	
   

  	
  •                  Annual review of Group’s complaint policies
  & procedures

  •                  Quarterly review of complaint log  

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  14.         QI oversight 

  	
   

  	
  Group to participate in BSC QI process by
  implementation, submission and evaluation of required audits and provision of
  data as needed for evaluation of processes and function.  

  	
   

  	
   

  	
   

  	
  •                  Pre-delegation on-site audit

  •                  Annual on-site audit

  •                  Committee meeting minutes

  •                  On-going review of Group delegation
  activities.  

  

 

*Quality Management is not a
delegatable function and therefore not subject to de-delegation.

 

90

 

ATTACHMENT II TO EXHIBIT F

 

BLUE SHIELD OF CALIFORNIA

UTILIZATION MANAGEMENT (UM)
REQUIREMENTS

 

	
  UM Standard per BSC

  	
   

  	
  Activities Delegated to Group

  	
   

  	
  Group

  Reporting

  Frequency to

  BSC

  	
   

  	
  BSC Oversight

  
	
  1                  UM program Structure & Process:

  •                  Programs

  •                  Work Plan

  •                  Annual Eval.

  	
   

  	
  Compose
  written UM Program description Work Plan and Plan Evaluation as outlined in
  BSC Delegation Standards.

  	
   

  	
  Annual

  	
   

  	
  Review
  and submission, annually, of:

  •                  UM Program

  •                  UM Work plan

  •                  UM Annual Eval.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2.               Prior-authorization

  	
   

  	
  Conduct
  prior authorization according to time frames description as outlined in BSC
  Delegation Standards.

  	
   

  	
  Frequency
  of reporting to BSC will be no less than quarterly.

  	
   

  	
  •                  Retro-review of referrals

  •                  Inter-Rater Reliability Studies

  •                  Authorization and Denials

  •                  Review trends in QI reporting and patient
  complaints

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  3                  Concurrent review

  	
   

  	
  Conduct
  concurrent review according to time frames description as outlined in BSC
  Delegation Standards.

  	
   

  	
  Frequency
  of reporting to BSC will be no less than quarterly.

  	
   

  	
  •                  Retro-review of concurrent review decisions

  •                  Bed day report 

  •                  Review trends in QI reporting and patient
  complaints

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  4.               Case Management –Coordination of care and
  services required to assure appropriate and timely intervention and care for
  chronic conditions, high risk, out of area, out of network cases, and
  difficult cases.

  	
   

  	
  Conduct
  case management according to time frames description as outlined in BSC
  Delegation Standards.

  	
   

  	
  Frequency
  of reporting to BSC will be no less than quarterly.

  	
   

  	
  •                  Retro-review of case management files

  •                  Review trends in Ql reporting and patient
  complaints

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  5.               Discharge Planning

  	
   

  	
  Conduct
  discharge planning according to time description as outlined in BSC
  Delegation Standards.

  	
   

  	
  Frequency
  of reporting to BSC will be no less than quarterly.

  	
   

  	
  •                  Retro-review of discharge planning cases 

  •                  Review trends in QI reporting and patient
  complaints

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  6.               DME

  	
   

  	
  Conduct
  DME according to time frames description as outlined in BSC Delegation
  Standards.

  	
   

  	
  Frequency
  of reporting to BSC will be no less than quarterly.

  	
   

  	
  •                  Retro-review of DME authorization and
  denials

  •                  Review trends in QI reporting and patient
  complaints

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  7.               Home Health

  	
   

  	
  Conduct
  DME according to time frames description as outlined in BSC Delegation
  Standards.

  	
   

  	
  Frequency
  of reporting to BSC will be no less than quarterly.

  	
   

  	
  •                  Retro-review of home health authorization
  and denials

  •                  Review trends in QI reporting and patient
  complaints

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  8.               Institutional Reporting

  	
   

  	
  Conduct
  concurrent review and monitoring for appropriateness and submission of
  reports/encounter data for all admits.

  	
   

  	
  Monthly
  to BSC.

  	
   

  	
  Assure
  institutional report is sent to accountable Health Plan monthly

  

 

91

 

	
  UM Standard per BSC

  	
   

  	
  Activities Delegated to Group

  	
   

  	
  Group

  Reporting

  Frequency to

  BSC

  	
   

  	
  BSC Oversight

  
	
  9.               Decision Criteria

  •                  Medical
  appropriateness

  •                  LOS

  •                  Catastrophic Case
  Management

  	
   

  	
  •                  Development of criteria.

  •                  Day-to-day monitoring of criteria in the
  in-patient and ambulatory settings.

  	
   

  	
  Frequency
  of reporting to BSC will be no less than quarterly.

  	
   

  	
  •                  Annual review of evidence of adoption of
  criteria

  •                  Inter-rater reliability study 

  •                  Bed day report 

  •                  Catastrophic case report

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  10.         Standards for UM Decision-making

  •                  Pre-authorizations

  •                  Referrals

  •                  Expedited
  referrals

  •                  Denials for
  medical necessity

  •                  Retrospective
  review

  •                  Concurrent review

  	
   

  	
  •                  Day-to-day accounting of In-patient review

  •                  Referrals management

  •                  Medical necessity decision-making for
  patients receiving care in in-patient and ambulatory settings within the
  industry and BSC defined parameters.

  	
   

  	
  Frequency
  of reporting to BSC will be no less than quarterly.

  	
   

  	
  •                  Review of denial letters for appropriate
  regulatory language and timeframes 

  •                  Retro-review of authorizations/ referrals/
  denials for medical necessity 

  •                  Bed day report 

  •                  Inter-rater reliability study.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  11.         OOA Patient Management

  	
   

  	
  •                  Day-to-day case management of out-of-area
  patients in in-patient and ambulatory settings when group is capitated for
  OOA management with BSC notification; BSC to manage when shared savings.

  	
   

  	
  Frequency
  of reporting to BSC will be concurrent, weekly, but in all cases no less than
  quarterly.

  	
   

  	
  •                  Bed day report

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  12.         Technology Assessment

  	
   

  	
  Group
  is responsible to report and coordinate authorization requests for care that
  is considered experimental and/or investigational. Group is responsible for
  the adherence to BSC P&Ps regarding the authorization of new technology
  and coordination of benefits interpretation.

  	
   

  	
  Concurrent

  	
   

  	
  •                  Review of IPA/MG submitted denials for
  appropriateness and compliance with BSC P&Ps

  •                  Review of Appeals overturned

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  13.         Continuity of Care.

  	
   

  	
  Group
  responsible for the development of P&P and ongoing day-to-day management
  of continuity of care issues as needed and in compliance with current
  regulatory requirements and BSC criteria.

  	
   

  	
   

  	
   

  	
  •                  Review and
  approval of submitted P&Ps

  •                  Annual review of
  utilization Management minutes of IPA/MG

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  14.         Behavioral
  Health Management

  	
   

  	
  Day to day
  case management of BH cases is the responsibility of the group. The group is
  further responsible for the coordination and continuity of care related to
  mental health care issues.

  	
   

  	
   

  	
   

  	
  •                  Review and
  approval of submitted P&Ps

  •                  Annual review
  of Utilization Management minutes of IPA/MG

  •                  Medical
  Records review PCPs with >50 members, every other year

  

 

92

 

	
  UM Standard per BSC

  	
   

  	
  Activities Delegated to Group

  	
   

  	
  Group

  Reporting

  Frequency to

  BSC

  	
   

  	
  BSC Oversight

  
	
  15.         Benefit Development Interpretation

  	
   

  	
  Compliance
  with benefit interpretation as provided by BSC.

  	
   

  	
  Concurrent
  submission of ALL denials.

  	
   

  	
  Concurrent
  review of denials.

  
	
  16.         Oversight of Delegated UM activities

  	
   

  	
  Preparation,
  maintenance, and availability of all documents that demonstrate UM/QM
  activity in keeping with regulatory compliance

  	
   

  	
  At
  least quarterly.

  	
   

  	
  Quarterly
  audits.

  

 

93

 

ATTACHMENT III TO EXHIBIT F

 

BLUE SHIELD OF CALIFORNIA

CREDENTIALING/DELEGATION REQUIREMENTS

 

	
  Standard per BSC

  	
   

  	
  Delegateable

  Status

  	
   

  	
  Activities Delegate to Group

  	
   

  	
  Group

  Reporting

  Frequency to

  BSC

  	
   

  	
  BSC Oversight

  
	
  1.               Credentialing structure & process:

  •                  Policies & procedures

  •                  Committee/Review body

  	
   

  	
  Non-delegateable
  establishment of standards

  	
   

  	
  Development &
  implementation of relevant policies and procedures:

  •                  Scope

  •                  Criteria

  •                  Decision-making

  •                  Committee/review body

  •                  Protection of provider rights

  •                  Medical Director or designee’s responsibilities

  •                  Peer Review/Disciplinary Action

  •                  Documentation of Agreement

  •                  Initial evaluation

  •                  Oversight organization retains right of
  approval/disapproval

  	
   

  	
  Annual

  	
   

  	
  Review of annual submission
  of:

  •                  Policies and Procedures

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2.               Appointment process

  	
   

  	
  Non-delegateable
  establishment of standards

  	
   

  	
  •                  Completion of application

  •                  Primary source verification

  •                  Verification of information from monitoring
  organizations

  •                  Identification of sanction activity 

  	
   

  	
  Group submits at least
  quarterly reports of which providers have been appointed or declined for
  appointment by the Credentials Committee

  	
   

  	
  BSC performs at least
  annual onsite review of a sampling of initial credentialing files and
  committee minutes.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  3.               Reappointment process

  	
   

  	
  Non-delegateable establishment
  of standards

  	
   

  	
  •                  Primary source verification

  •                  Review of information from monitoring
  organizations within 180 days of credentialing

  •                  PCP Performance appraisal which includes:
  member complaints, QI results, UM reports, and member satisfaction (optional)

  •                  Reappointment is performed at least every
  two years.

  	
   

  	
  Group submits at least
  quarterly reports of which providers have been re-appointed or declined for
  reappointment by the Credentials Committee

  	
   

  	
  BSC performs at least
  annual on-site review of a sampling of re-credentialing files and committee minutes.

  

 

94

 

	
  Standard per BSC

  	
   

  	
  Delegateable

  Status

  	
   

  	
  Activities
  Delegated to Group

  	
   

  	
  Group

  Reporting

  Frequency to

  BSC

  	
   

  	
  BSC
  Oversight

  
	
  4.     Office
  Site Visits

  	
   

  	
  Non-delegateable establishment of 

  standards 

  	
   

  	
  •      Initial office site visit
  for potential PCP’S and OB/Gyn’s which includes evaluation of medical record
  keeping practices 

  •      At the time of
  recredentialing, an office site visit for high volume PCP’s which includes 

  •      Evaluation of medical
  record keeping practices 

  	
   

  	
  N/A

  	
   

  	
  BSC performs at least, annual review of:

  •      Policies & procedures describing
  office site visits 

  Initial and re-appointment files to assess
  evidence of office site visits 

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  5.     Credentialing
  file maintenance

  	
   

  	
  Non-delegateable 

  establishment of 

  standards 

  	
   

  	
  •      Maintenance of individual
  provider credentialing/ recredentialing files. 

  •      Submission of copy of 

  provider
  credentialing 

  recredentialing
  file at the 

  request
  of BSC 

  	
   

  	
  As requested for governmental, accreditation and
  regulatory review.

  	
   

  	
  BSC performs at least 

  annual review of:

  •      Policies & procedures describing
  submission of files upon request of BSC for the purposes of meeting
  governmental, accrediting and regulatory agency review requests. 

  BSC requests for copy of credentialing/
  recredentialing file for review by governmental, accrediting and regulatory
  agency review will be within the required time frame of requesting agency. 

  

 

95

 

ATTACHMENT
IV TO EXHIBIT F

 

BLUE SHIELD OF CALIFORNIA

CLAIMS PROCESSING REQUIREMENTS

 

	
  Standard per BSC

  	
   

  	
  Activities
  Delegated to Group

  	
   

  	
  Group
  Reporting

  Frequency to BSC

  	
   

  	
  BSC
  Oversight

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1.
  Payment

  •                  Timeliness

  •                  Payment Accuracy

  •                  Denials 

  	
   

  	
  Payment /processing of claims for all services
  which are the Group’s responsibility per this agreement and state or federal
  regulations.  

  	
   

  	
  Monthly  

  	
   

  	
  Monthly report review.
  Periodic audits  

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2. Claims Forwarding
  

  	
   

  	
  Forwarding of claims which are not the group’s
  payment responsibility within industry standard of 8 calendar days.  

  	
   

  	
  None  

  	
   

  	
  As required.  

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  3. Self-Monitoring and Reporting  

  	
   

  	
  Internal quality assurance testing
  procedures.  Monthly report submission
  per industry standard format.  

  	
   

  	
  Monthly  

  	
   

  	
  Monthly report review.
  Periodic audits.  

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  4. Sub-delegation of claims processing through
  capitation. (This does not refer to a TPA or management company arrangement
  for Group’s entire claims processing.)  

  	
   

  	
  Continued compliance with all requirements.
  Monitor sub-delegated claim shops employing all means used by Blue Shield or
  government regulators in their oversight. If sub-capitated organization
  engages a TPA or management company, those must be audited by Group.  

  	
   

  	
  Monthly including breakout of sub-capitated
  entities.  

  	
   

  	
  Periodic audits  

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  5. Audits and Audit Preparation and
  Follow-Up (for CMS, DMHC, BSC)  

  	
   

  	
  Preparation including producing accurate claims
  universe lists, providing detailed information in a standard questionnaire,
  selecting and retrieving requested documents; claims, back-up records,
  checks/payment confirmation, and written corrective action plans in
  accordance with BSC instructions.  

  	
   

  	
  As requested  

  	
   

  	
  Periodic audits Random
  focused audits Focused reviews  

  

 

96

 

Exhibit G-1

 

HMO
IPA/Medical Group Agreement

 

BLUE SHIELD
65 Plus PROVISIONS

 

NORTHWEST
ORANGE COUNTY MEDICAL GROUP

 

Effective
Date: NA

 

Group
and Group Physicians specifically agree to serve Blue Shield 65 Plus Members
pursuant to the terms and conditions of this Agreement and the following
requirements:

 

1.                                       This Agreement shall apply to Blue Shield 65
Plus Members who are enrolled in Blue Shield’s Medicare+ Choice Plan.

 

2.                                       DEFINITIONS – The following definitions shall apply for
Blue Shield 65 Plus Members in addition to the Definitions set forth in
Article I of the Agreement:

 

A.                                   “Emergency
Medical Condition” shall mean a medical condition manifesting itself by
acute symptoms of sufficient severity (including severe pain) such that a
prudent layperson, with an average knowledge of health and medicine, could
reasonably expect the absence of immediate medical attention to result in (1)
serious jeopardy to the health of the individual or, in the case of a pregnant
woman, the health of the woman or her unborn child; or (2) serious impairment
to bodily functions; or (3) serious dysfunction of any bodily organ or part.

 

B.                                     ‘‘Emergency
Services” shall mean those medical and hospital services required that are
(i) furnished by a Physician qualified to furnish emergency services; and (ii)
needed to evaluate or stabilize an Emergency Medical Condition.

 

C.                                     “Member”
shall mean a Medicare beneficiary who is enrolled in the Health Plan’s
Medicare+Choice program (“Blue Shield 65 Plus Choice Plan”) who is assigned to
a Group Physician and Hospital.

 

D.                                    “Urgently
Needed Services” will mean medical services received outside of the Service
Area which are, in the judgment of a prudent layperson, required without delay
in order to prevent serious deterioration of Enrollee’s health as a result of
an illness or injury.

 

3.                                       OBLIGATIONS OF GROUP – The Obligation set forth in
Article II.  Paragraph 2.6 of the
Agreement is modified to add the following at the end of current text of
Paragraph 2.6 and shall apply to Blue Shield 65 Plus Members:

 

“Group will
comply and have its Group Providers comply with state and federal laws and
regulations including but not limited to physician incentives, and stop loss
insurance requirements.  Group shall
include in its contracts with Group

 

97

 

Providers all
provisions required by federal and state laws, including the BBA and related
regulations.  Group shall ensure that,
on or before December 31, 1999, all contracts with Group Providers comply
with all applicable Medicare+Choice regulations as described in this Exhibit
H.  and as outlined in the Provider
Manual.  Further, to the extent Group
subcapitates other provider organizations and the contracts with such
organizations delegate to the organization responsibility for claims
processing, including the right to pay or deny claims, Group’s contracts with
such Group Providers shall require that they comply with the provisions of this
Exhibit G-1.  Further, Group shall
comply with the provisions set forth in Exhibit F of this Agreement and in the
Provider Manual.”

 

The Obligation
set forth in Article II.  Paragraph
2.12 of the Agreement is modified to add the following at the end of the
current text of Paragraph 2.12 and shall apply to Blue Shield 65 Plus Members:

 

“Submission
of Electronic Encounter Data.  Group
agrees to furnish Blue Shield with complete encounter data for Capitated
Professional Services rendered to Members in the HCFA 1500 format.  The encounter data will be furnished to Blue
Shield through Electronic Data Interchange and shall be received by Blue Shield
ninety (90) days following the date of service.  Group also agrees to furnish medical records that may be required
to obtain any additional information or corroborate the encounter data.  Group further agrees to have its CEO attest
and certify the completeness and truthfulness of the encounter data
submitted.  Failure by Blue Shield to
receive encounter data within stipulated time frame will result in Group receiving
reduced compensation as described in Paragraph 7.11 of this Agreement as well
as grounds for termination of this Agreement.”

 

4.                                       COMPLIANCE WITH LEGAL
REQUIREMENTS – In addition
to the requirements set forth in Article XIII, of the Agreement, the following
new Paragraphs shall also apply:

 

“13.7                     Provider
Terminations.  If Blue Shield
terminates a Group Provider without cause, Blue Shield must provide Group at
least sixty (60) days notice.  If Group
terminates a Group Provider without cause, Group must provide Blue Shield at
least sixty (60) days notice.

 

“13.8                     Medicare+Choice.  Group will comply and have its Group
Providers comply with state and federal laws and regulations including but not
limited to physician incentives, and stop loss insurance requirements.  Group shall submit to Blue Shield on an
annual basis descriptive information regarding its Physician Incentive Plan
(PIP) as required by CMS.  Group shall
submit such information utilizing the CMS PIP Disclosure Forms.  Group shall include in its contracts with
Group Providers all provisions required by federal and state laws, including
the BBA and related regulations.  Group
shall ensure that, on or before December 31, 1999, all contracts with
Group Providers comply with all applicable

 

98

 

Medicare+Choice
regulations as described in this Amendment and as outlined in the Provider
Manual.

 

Group
understands that payments made by Blue Shield are, in whole or in part, derived
from federal funds, and therefore provider and its subcontractors are subject
to certain laws that are applicable to individuals and entities receiving
federal funds.  Group agrees to comply
with all applicable Medicare laws, regulations and CMS instructions including
Title VI of the Civil Rights Act of 1964, Section 504 of the
Rehabilitation Act of 1973, the Age Discrimination Act of 1975, the Americans
with Disabilities Act, and to require their subcontractors to do the same.  Group agrees to include the requirements of
this section in its contracts or subcontracts with other Participating
Providers or entities.

 

In making
payments to Group Physicians and other Group Providers for Covered Services,
Group shall comply with the timeliness requirements set forth in applicable
federal law, including, but not limited to, any applicable CMS rules and
regulations.

 

13.9                           CMS
Participation Requirements.  Group
is prohibited from employing or contracting with an individual who is excluded
from participation in Medicare for the provision of any of the following:
healthcare services, utilization review services, medical social work services
and administrative services.  In the
event Group fails to comply with the above, Blue Shield reserves the right to
pass through to the Group any sanctions imposed by CMS for violation of this
prohibition.

 

13.10                     Organization
Determination Process.  Blue Shield
may delegate the process of utilization management to the Group.  If such delegation occurs, Group shall
comply with Medicare regulations and CMS instructions pertaining to timely
organization determinations by Group as to whether to provide, deny, reduce or
discontinue a Covered Service to a Member. 
Such determinations shall be made in accordance with procedures and
instructions set forth in the Provider Manual. 
Group shall submit to Blue Shield on a monthly basis a report which
tracks the requests for organization determinations and expedited reviews and
the timeframe within which decisions were made by Group.  This section is subject to change as determined
by CMS regulations, policies and instructions.

 

13.11                     Private
Contract.  Group understands that
Blue Shield is prohibited by CMS from paying capitation to, or including in its
network, any provider that has entered into a private contract with a Member
for the provision of services.  Blue
Shield reserves the right to terminate any such provider from its network.  Further, if the provider so terminated was a
Group Physician, Blue Shield shall have the right to reduce Group’s capitation
by the amount of any capitation that was paid either directly or indirectly to
such provider(s).  This provision shall
remain in effective for a period of two (2) years from the time that all direct
contracts between provider and Member have been terminated.

 

99

 

13.12                     Health
Assessment.  Blue Shield must
conduct a health assessment of all Members within ninety (90) days of the
effective date of Member’s enrollment with Blue Shield.  Group agrees to cooperate in such health
assessment process.

 

13.13                     Utilization
Management Plan.  Prior to the
execution of this Agreement, and if utilization management functions are
delegated to Group by Blue Shield, Group will provide Blue Shield with a
written Utilization Management Plan for the purpose of review and approval by
Blue Shield.  Group shall notify Blue
Shield within thirty (30) days of any changes involving the rules, regulations,
authorities and responsibilities for the Utilization Management Plan, which
shall be subject to reasonable approval thereof by Blue Shield.  The Utilization Management Plan shall
include procedures approved by Blue Shield to identify, assess, establish, and
implement a treatment plan for Members who have complex or serious medical
conditions, and for direct access of Members to services as mandated by the BBA
and related regulations.  Group agrees
to comply with Blue Shield’s Medical Policies. 
All Group denial letters shall be reviewed and approved by Blue
Shield.  Group agrees to cooperate with
Blue Shield in furnishing the required reports identified in the Provider
Manual.”

 

5.                                       PLAN QUALITY IMPROVEMENT – Following Paragraph 2.7 of the Agreement,
the following provisions shall also apply.

 

“Blue Shield
retains responsibility for Quality Improvement and Quality Management
Programs.  Quality Improvement and
Quality Management Programs are not delegated to Group.  Group however agrees to comply with Blue
Shield’s Quality Improvement Program for both hospital and office based
care.  Blue Shield’s Quality Improvement
Program shall be developed in consultation with Blue Shield Providers to ensure
that practice guidelines of quality improvement and quality management pursuant
to Medicare regulations and CMS instructions are met.  Group agrees to maintain a Quality Management Program which
states that Group will review on a prospective, concurrent and retrospective
basis the quality, appropriateness, level of care and utilization of Group
Providers.  The Quality Management
Program will include among others an annual evaluation, annual quality
management goals, proposed quality management studies, a description of the
quality management committee and frequency of meetings.  Group shall notify Blue Shield of any
changes to the Quality Management Plan which shall be subject to prior approval
by Blue Shield.”

 

6.                                       PROVIDER MANUAL – In Article V, of the Agreement, the
following provisions shall be added to the end of Paragraph 5.2:

 

Precedence. 
The Provider Manual and all revisions thereto shall be consistent with
the laws and regulations governing the Medicare+Choice program, the regulations
established by CMS, the Knox-Keene Act and the provisions of this
Agreement.  In the event of any conflict
or inconsistency between the Provider Manual, the Agreement, and/or any of the
cited state or federal laws and

 

100

 

regulations,
the provision which governs shall be determined by apply the following order of
precedence: the BBA, CMS regulations and instructions, the Knox-Keene Act and
regulations, the Agreement and, then, the Provider Manual.

 

***

 

101

 

Exhibit G- 2

 

HMO
IPA/Medical Group Agreement

 

BLUE SHIELD
POS PROVISIONS

 

NORTHWEST
ORANGE COUNTY MEDICAL GROUP

 

Effective
Date: February 1, 2003

 

This
Exhibit implements the Blue Shield HMO POS Benefit Program (“BSC POS”) pursuant
to which BSC POS Members may receive Covered Services on either an In-Network
Services or Out-of-Network Services basis (as defined below).

 

1.                                       Definitions.  In addition to the
definitions set forth in the Agreement, the following definitions apply to this
Exhibit G-2:

 

(a)                                  BSC
POS Member refers to a Member enrolled in the BSC HMO POS Benefit Program.

 

(b)                                 In-Network
Services refers to Covered Services which are not Out-of-Network Services.

 

(c)                                  BSC
POS Institutional Services are those Covered Services provided to a BSC POS
Member, which are identified in the Division of Financial Responsibility
(Exhibit B.) as Shared Savings (other than Outpatient Prescription Drugs).

 

(d)                                 BSC
POS Professional Services are Covered Services provided to a BSC POS Member
which are defined as Capitated Professional Services in Paragraph 1.5 of the
Agreement.

 

(e)                                  Out-of-Network
Services refers to Covered Services provided to a BSC POS Member on the
basis of the Member’s self-referral, other than: (i) Services provided by the
Member’s PCP (or physician providing on-call coverage for such PCP); (ii)
Emergency or Urgent Care Services not requiring authorization under Blue Shield’s
utilization management rules; or, (iii) Services not requiring a PCP referral
or authorization from Blue Shield and/or Group or which Members, in general,
have a right to self-refer.

 

2.                                       Financial Responsibility.  The
Capitation payable to Group pursuant to Exhibit C shall cover, and Group shall
be financially responsible for all BSC POS Professional Services which are
In-Network Services.  Except as
otherwise provided herein, Blue Shield shall be financially responsible for
Out-of-Network BSC POS Professional Services provided by providers who are not
Group Providers.  Those BSC POS
Professional Services which are Blue Shield’s financial responsibility
hereunder will be included in the POS Out-of-Network Professional Fund
settlement described in Paragraph 8 of this Exhibit G-2.  Those BSC POS Out-of-Network Institutional

 

***
Confidential Treatment requested.

 

102

 

Service which
are the financial responsibility of Blue Shield, will be included in the POS Out-of-Network
Institutional Fund settlement described in Paragraph 9 of this Exhibit
G-2.  Covered BSC POS In-Network
Institutional Services which are identified as Shared Savings Services in
Exhibit B will be included in the POS In-Network Shared Savings Fund settlement
described in Paragraph 7 of this Exhibit G-2. 
Covered outpatient prescription drug services which are Blue Shield’s
responsibility will be included in the Pharmacy Shared Savings Fund settlement
described in Exhibit D.

 

3.                                       Administrative Services.  As
set forth in the Provider Manual, Blue Shield shall advise Group as to which
Members are BSC POS Members.  In
addition:

 

(a)                                  Following
Blue Shield’s receipt of a claim for BSC POS Professional Services, Blue
Shield, within such time frames as set forth in the Provider Manual, shall
provide a copy of such claim to Group. 
Thereafter, and within such time frames as set forth in the Provider
Manual, Group shall make an initial determination, and so advise Blue Shield in
writing, as to which of such claims are for In-Network Services, which are for
Out-of-Network Services provided by a Group Provider, and which are for
Out-of-Network Services provided by other than a Group Provider.

 

(b)                                 In
the event that Group (rather than Blue Shield) receives a claim for BSC POS
Professional Service which it determines to be for Out-of-Network Services
provided by other than a Group Provider, Group shall, within such time frames
as set forth in the Provider Manual, provide Blue Shield with a copy of the
claim and its initial determination.

 

(c)                                  In
the event a Group Provider refers a BSC POS Member for a Covered Service on an
In-Network basis, but the Group Provider, rather than the Member, fails to
comply with Group’s utilization management requirements, such Covered Service
shall be deemed an In-Network Service, and the Member’s financial
responsibility shall be limited to the applicable Copayment for In-Network
Services.  The Group may refuse to
compensate a Group Provider for such services to the extent permitted in its
contract with the Group Provider providing the service.

 

(d)                                 Blue
Shield may, on its own initiative, or in the event a BSC POS Member or a
provider disputes Group’s initial determinations made pursuant to this
Paragraph 3, adjudicate whether a service was an In-Network or Out-of- Network
Service and if an Out-of-Network Service, whether or not provided by a Group
Provider.  Blue Shield may also, at its
expense and upon reasonable notice to Group, periodically audit Group’s initial
determinations made pursuant to this Paragraph 3.  Group shall cooperate with such audits and adjudications and
provide such information and documentation regarding its initial determinations
as reasonably requested by Blue Shield. 
Subject to the Dispute Resolution provisions in this Agreement, Blue

 

103

 

Shield’s determination shall be binding upon Group.  Subject to such dispute resolution
procedures: (i) In the event that Blue Shield determines that it has
erroneously paid for services as Out-of-Network Services from non-Group
Providers, which were, in fact, In-Network Services (or Out-of-Network Services
provided by Group Providers), such amounts shall within ninety (90) days
following notice by Blue Shield to Group of such determination (and the
completion of any requested dispute resolution procedures) be refunded to Blue
Shield by Group and Blue Shield may, with advance written notice, off-set such
amounts from any monies owed to Group by Blue Shield; and (ii) In the event
that Blue Shield determines that Group has erroneously paid for BSC POS
Professional Services as In-Network Services or Out-of-Network Services
provided by Group Providers which were, in fact, Out-of-Network Services
provided by non-Group Providers, Blue Shield shall within ninety (90) days
after such determination, or within ninety (90) days after such determination
is made through the requested dispute resolution procedures, refund the amounts
so paid to Group.

 

(e)                                  Summaries
& Settlements:  Blue Shield
shall provide to Group on a quarterly basis a summary of the funding and
expenses in the Shared Savings Program.

 

4.                                       Additional Group Payment Responsibility. 
Notwithstanding any provision of this Exhibit G-2 to the contrary, Group
shall be financially responsible for Out-of- Network Covered Services provided
by Non-Group Providers to the extent such services were obtained by the BSC POS
Member on an Out-of-Network basis as a direct result of Group’s failure, on an
In-Network basis, to timely provide or arrange for such Covered Services for
the BSC POS Member.  Such services shall
be excluded from the POS Out-of-Network Fund settlement.

 

5.                                       Group Cooperation with Out-of-Network
Providers.  In the event that a BSC POS Member elects to
obtain Out-of-Network Services, Group shall cooperate with the provider of such
Out-of-Network Services to ensure coordination and continuity of care and, upon
request of such provider of Out-of-Network Services (and with the BSC POS
Member’s written authorization), provide copies of the BSC POS Member’s
relevant medical records to such provider.

 

6.                                       Coordination of Benefits for Out-of-Network
Claims.  Blue Shield is solely entitled to collect
and retain any and all third party liens, coordination of benefits, or any
other payments obtained from third party payments for Out-of-Network Services
provided to BSC POS Members by non-Group Providers.  Any funds received by Blue Shield for POS Out-of-Network services
shall be credited by Blue Shield in the POS Out-of-Network Fund settlement
described in Paragraph 7, of this Exhibit G-2.

 

7.                                       POS In-Network Shared Savings Fund Settlement. 
Blue Shield shall establish a POS In-Network Shared Savings Fund as
follows.

 

104

 

a.               Funding:  For BSC POS Members Blue Shield will
allocate to a POS In- Network Shared Savings Fund a per Member per month amount
set forth in Schedule 1 to this Exhibit G-2 for all Members assigned to
Group, subject to retroactive adjustments either upward or downward due to
retroactive changes in membership.

 

b.              Charging of Payments:  Blue Shield shall charge against the POS
In-Network Shared Savings Fund all payments made by Blue Shield for such BSC
POS Members during the annual term of the Agreement for In-Network services
which are designated as Shared Savings Services in Exhibit B, less payments
received by Blue Shield as a result of third-party reimbursement.  Workers’ Compensation recoveries and
coordination of benefits payments.  Blue
Shield shall include any payments for Shared Savings Services which are paid
prior to the date of the settlement, as well as a reasonable allowance, as
determined by Blue Shield’s actuaries, for incurred but not paid (IBNP)
claims.  Any costs for Shared Savings
Services not included in any annual settlement shall be carried forward and
included in the Shared Savings settlement for the succeeding Agreement Year.

 

c.               POS In-Network Shared Savings Fund
Settlement:  The POS In-Network
Shared Savings Fund shall be settled on an annual basis, within one hundred
eighty (180) days following the end of each annual term of the Agreement (being
a one hundred twenty (120) day claims run out and a sixty (60) day
determination period).  In the event of
termination of the Agreement for any reason, final settlement of the POS
In-Network Shared Savings Fund shall be performed one hundred fifty (150) days
after the date of termination and any amounts due from Blue Shield to Group
shall be paid within thirty (30) days thereafter.

 

d.              If the total actual cost of Shared
Savings services is less than the total allocation to the POS In-Network Shared
Savings Fund, then Group shall be entitled to fifty percent (50%) of the amount
by which the allocation exceeds the costs, not to exceed thirty-five percent
(35%) of POS Capitation Fees, minus any carry forward resulting from deficits
from previous Agreement years.

 

e.               If the total actual cost of Shared
Savings services is more than the total allocation to the POS In-Network Shared
Savings Fund, then fifty percent (50%) of the amount, by which the actual costs
exceed the total allocation, not to exceed fifteen percent (15%) of the POS
Capitation Fees, shall be allocated to Group and shall be handled as follows:
(i) the excess may be deducted from any other settlements or payments, except
Capitation and Professional Stop Loss Program payments made pursuant to Exhibit
H, due to Group from Blue Shield, and, (ii) any remaining amounts shall be
carried forward into future Agreement Years and shall be deducted from any
Shared Savings payments to Group in future years.

 

105

 

8.                                       POS Out-of-Network Professional Fund
Settlement.  Blue Shield shall establish a POS
Out-of-Network Professional Fund.

 

a.               Funding of Out-of-Network Professional
Fund - Blue Shield will allocate on a monthly basis the amounts set forth
in Schedule 1 to this Exhibit G-2 for all BSC POS Members assigned to
Group, subject to retroactive adjustments due to retroactive changes in members
(the “POS Out-of-Network Professional Budget”).

 

b.              Allocation of POS Out-of-Network
Professional Expenses - The POS Out-of- Network Professional Fund shall be
charged for all Covered Out-of-Network Professional services which are paid by
Blue Shield for BSC POS Members assigned to Group (the ‘‘POS Out-of-Network
Professional Expenses”).

 

c.               Timing of POS Out-of-Network
Professional Fund Settlement – On an Agreement year basis.  Blue Shield shall perform a reconciliation
of the POS Out-of-Network Professional Fund. 
Such settlement shall be performed within one hundred twenty (120) days
following the end of the Agreement Year. 
Any amounts due from Blue Shield to Group shall be paid within sixty
(60) days thereafter.  In the event of
termination of the Agreement for any reason, final settlement of the POS
Out-of-Network Professional Fund shall be performed one hundred fifty (150)
days after the date of termination and any amounts due from Blue Shield to
Group shall be paid within thirty (30) days thereafter.

 

d.              Out-of-Network Professional Fund
Surplus –  For any Agreement
Year in which the POS Out-of-Network Professional Budget exceeds the POS
Out-of-Network Professional Expenses, IPA shall be entitled to 100% of the POS
Out-of- Network Professional Fund surplus, minus any POS Out-of-Network
Professional Fund or POS Out-of-Network Institutional Fund deficit carried
forward from a previous Agreement Year.

 

e.               Out-of-Network Professional Fund
Deficit – For any Agreement Year in which the POS Out-of-Network
Professional Expenses exceed the POS Out-of- Network Professional Budget, forty
percent (40%) of the amount by which the actual costs exceed the total
allocation, not to exceed five percent (5%) of the POS Capitation Fees, shall
be allocated to the Group and shall be handled as follows: Blue Shield shall
offset any out-of-network Professional deficit against any out-of-network
Institutional surplus.  If a deficit
results, Blue Shield shall carry such deficit forward into future Agreement
Years and the deficit carryover shall be offset against any Out-of-Network
Professional or Institutional Fund Surpluses in future years.  In the event the Deficit carried forward
exceeds the Surplus in a future year, the remaining deficit shall continue to
be carried forward and offset against any Surpluses in subsequent years.

 

9.                                       POS Out-of-Network Institutional Fund
Settlement.  Blue Shield shall establish a POS
Out-of-Network Institutional Fund.

 

106

 

a.               Funding of Out-of-Network
Institutional Fund - Blue Shield will allocate on a monthly basis the
amounts set forth in Schedule 1 to this Exhibit G-2 for all BSC POS
Members assigned to Group, subject to retroactive adjustments due to
retroactive changes in members (the “POS Out-of-Network Institutional Budget”).

 

b.              Allocation of POS Out-of-Network
Institutional Expenses - The POS Out-of-Network Institutional Fund shall be
charged for all Covered Out-of-Network Institutional services which are paid by
Blue Shield for BSC POS Members assigned to Group (the “POS Out-of-Network
Institutional Expenses”).

 

c.               Timing of POS Out-of-Network
Institutional Fund Settlement - On an Agreement Year basis, Blue Shield
shall perform a reconciliation of the POS Out-of-Network Institutional
Fund.  Such settlement shall be performed
within one hundred twenty (120) days following the end of the Agreement
Year.  Any amounts due from Blue Shield
to Group shall be paid within sixty (60) days thereafter.  In the event of termination of the Agreement
for any reason, final settlement of the POS Out-of-Network Institutional Fund
shall be performed one hundred fifty (150) days after the date of termination
and any amounts due from Blue Shield to Group shall be paid within thirty (30)
days thereafter.

 

d.              Out-of-Network Institutional Fund Surplus
– For any Agreement Year in which the POS Out-of-Network Institutional Budget
exceeds the POS Out-of-Network Institutional Expenses, IPA shall be entitled to
sixty percent (60%) of the POS Out-of-Network Institutional Fund surplus, not
to exceed thirty-five percent (35%) of POS Capitation Fees, minus any POS
Out-of-Network Professional Fund or POS Out-of-Network Institutional Fund
deficit carried forward from a previous Agreement year.

 

e.               Out-of-Network Institutional Fund
Deficit – For any Agreement Year in which the POS Out-of-Network
Institutional Expenses exceeds the POS Out-of-Network Institutional Budget,
then, forty percent (40%) of the amount by which the actual costs exceed the
total allocation, not to exceed five percent (5%) of POS Capitation Fees, shall
be allocated to the Group and handled as follows: (i) Blue Shield shall offset
any out-of-network Institutional deficit against any out-of-network
Professional surplus, and (ii) any remaining deficit shall be carried forward
into future Agreement Years and offset against any Out-of-Network Professional
or Institutional Fund Surpluses in future years.  In the event the Deficit carried forward exceeds the Surplus in a
future year, the remaining deficit shall continue to be carried forward and offset
against any Surpluses in subsequent years.

 

***

 

107

 

Exhibit G-2, Schedule 1

 

HMO IPA/Medical Group Agreement

POS Fund Allocations for NorthWest Orange
County Medical Group

Effective Date: 02/01/2003

 

As of 02/01/2003, the effective net yield
(which includes the deduction for Stop Loss, if applicable) for the following
PMPMs are *** or the POS In-network Shared Saving.  *** for POS Out-of-network Professional, and *** for the POS
Out-of-network Institutional, based on the 07/01/2002 membership.

 

The actual allocation to POS Fund for each
month will be calculated based on the actual member mix for each age/sex
category.

 

Members Other Than Blue Shield 65 Plus
Members

 

	
  Age &
  Sex Categories and POS Fund Allocations

  
	
  Category

  	
   

  	
  POS Fund
  Allocation (PMPM)

  
	
  Sex

  	
   

  	
  Age

  	
   

  	
  IN-NETWORK

  SHARED SAVINGS

  	
   

  	
  OUT-OF-NETWORK

  PROFESSIONAL

  	
   

  	
  OUT-OF-NETWORK

  INSTITUTIONAL

  
	
  F

  	
   

  	
  0 - 1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  65 + (M)*

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  0 - 1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  65 + (M)*

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  

 

* = Medicare Primary

 

*** All
references to the POS Fund Allocations have been deleted.

 

108

 

Exhibit G-2.1, Schedule 1

 

HMO IPA/Medical Group Agreement

POS Fund Allocations for North West Orange
County Medical Group

Effective Date: 02/01/2004

 

As of 02/01/2003, the effective net yield
(which includes the deduction for Stop Loss, if applicable) for the following
PMPMs are *** for the POS In-network Shared Saving, *** for POS Out-of-network
Professional, and *** for the POS Out-of-network Institutional, based on the
07/01/2002 membership.

 

The actual allocation to POS Fund for each
month will be calculated based on the actual member mix for each age/sex
category.

 

Members Other Than Blue Shield 65 Plus
Members

 

Age & Sex Categories and POS Fund
Allocations

 

	
  Category

  	
   

  	
  POS Fund
  Allocation (PMPM)

  
	
  Sex

  	
   

  	
  Age

  	
   

  	
  IN-NETWORK

  SHARED SAVINGS

  	
   

  	
  OUT-OF-NETWORK

  PROFESSIONAL

  	
   

  	
  OUT-OF-NETWORK

  INSTITUTIONAL

  
	
  F

  	
   

  	
  0 - 1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  65 + (M) *

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  0 - 1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  65 + (M) *

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  

 

* = Medicare Primary

 

*** All
references to the POS Fund Allocation have been deleted.

 

109

 

EXHIBIT H

 

HMO
IPA/Medical Group Agreement

PROFESSIONAL
STOP LOSS PROGRAM

NORTHWEST
ORANGE COUNTY MEDICAL GROUP

 

Effective
Date: NA

 

A.                                   Commencement of Stop Loss Program:

 

If, as set
forth on the Signature Page to the Agreement, Group elects to participate in
this Stop Loss Program, this Exhibit H is added to the HMO Medical Agreement
(the “Agreement”) between Group and Blue Shield.  The Stop Loss Program set forth in this Exhibit I commences with
respect to Capitated Professional Services provided to Members on the following
date:

 

	
   

  	
   

  	
  The
  Effective Date of the Agreement

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  OR,

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [Specify
  Date]

  	
   

  	
   

  	
  ,
  19

  	
   

  
							

 

The
commencement date for this Stop Loss Program shall not cause either a
modification of the Agreement Year, as set forth in the Agreement, nor, if the
initial time period covered by the Stop Loss Program is less than a full
Agreement Year, a proration of the Attachment Level set forth below.

 

Notwithstanding
any provision of the Agreement or this Exhibit H to the contrary, Blue Shield
shall have no obligation to permit Group to commence the Stop Loss Program
other than as of the first day of an Agreement Year.

 

B.                                     Termination or Modification of Stop Loss
Program:

 

(1)                                  Group
may at anytime, without terminating the Agreement and by no less than sixty
(60) days prior written notice to Blue Shield, terminate this Stop Loss Program
and (delete this Exhibit from the Agreement), provided that Group provides to
Blue Shield, in conjunction with such termination notice, a certificate of
insurance demonstrating that Group has (or will have as of the effective date
of such termination) stop loss coverage in compliance with Paragraph 7.4 of the
Agreement.  In the event of such
termination, the Stop Loss Attachment Level described below will not be
prorated.

 

(2)                                  Blue
Shield may, without terminating the Agreement and by no less than sixty (60)
days prior written notice to Group, terminate this Stop Loss Program as to
Group (and delete this Exhibit from the Agreement) as of midnight of the last
day of the Agreement Year.

 

***
Confidential Treatment requested

 

110

 

(3)                                  Blue
Shield may, by no less than sixty (60) days prior written notice to Group,
modify the provisions of this Stop Loss Program, including without limitation
the Stop Loss Program Charges specified below. 
Such modification shall be effective as of the first day of the Agreement
Year which immediately follows the Agreement Year in which such notice is
given.

 

C.                                     Stop Loss Program:

 

(1)                                  For
the Stop Loss Program Charges set forth in Part D below, Blue Shield shall
reimburse Group for eighty percent (80%) of that portion of the Allowable Costs
(as described herein) of Capitated Professional Services provided during any
one (1) Agreement Year to any one (1) Member which exceeds the Attachment Level
and which are Group’s financial responsibility under the Agreement.

 

(2)                                  In
addition to the defined terms of the Agreement, the following terms have the
following meanings for this Stop Loss Program:

 

(i)                                     The
Attachment Level is ten thousand dollars ($10,000) of Allowable Costs
incurred by Group for the provision of Capitated Professional Services to any
one (1) Commercial Member (including POS Members) in any one (1) Agreement
Year.  The Attachment Level is fifteen
thousand dollars ($15,000) of Allowable Costs incurred by Group for the
provision of Capitated Professional Services to any one (1) Blue Shield 65 Plus
Member in any one (1) Agreement Year.

 

(ii)                                  Allowable
Costs (both for determining the Attachment Level and Stop Loss Program
reimbursement after the Attachment Level is reached) are the lesser of the
amount actually paid (other than capitation payments) by Group for such
Capitated Professional Services, or ninety percent (90%) of the Blue Shield’s
PPO Physician Allowances in effect at the time.  Allowable Costs are reduced by: (a) the Member’s applicable
Copayments; and (b) any amount for which Group is entitled to reimbursement or
payment from any other source.

 

(3)                                  Group
shall submit to Blue Shield any claims for Stop Loss Program reimbursement
within ninety (90) days of the end of the Agreement Year in which the services,
for which Stop Loss Program reimbursement is claimed, were provided.  Blue Shield may deny any claims not
submitted within said time period. 
Claims shall be in such form, containing such information, and provided
to Blue Shield as set forth in the Provider Manual.

 

111Exhibit 10.164

 

Amendment to HMO IPA/Medical Group Shared Savings Provider Agreement
between California Physicians’ Service dba Blue Shield of California and
Northwest

 

*** Confidential Treatment requested

 

 

AMENDMENT NO. I

 

The HMO IPA/Medical Group Shared Savings Provider Agreement between
California Physicians’ Service, dba. 
Blue Shield of California (“BSC-HMO”), and NORTHWEST ORANGE COUNTY MEDICAL GROUP (“Medical Group”), with
an effective date of February 1, 2003
is further amended effective February 1, 2003
as follows:

 

Section 1.2 Authorization
is amended to read in full as follows

 

Authorization.  Is the procedure for obtaining the prior
approval of Blue Shield, or its designee (which may include Group), for
the provision or referral of Covered Services when such approval is required by
Blue Shield.

 

Section 1.5 Capitated Professional Services is amended in full
to read as follows:

 

Capitated Professional Services:  are those Covered Services which are
described in Exhibit B, hereto as the financial responsibility of Group.  Capitated Professional Services also include
any Covered Services which are not listed in Exhibit B., but which are
customarily provided by IPAs, Medical Groups to their patients.  Blue Shield may periodically amend Capitated
Professional Services to include any additional physician and/or ancillary
services, which must be provided by law. 
See Section 7.12 Material Change of Circumstances.

 

Section 1.17 Provider Manual is amended in full to read as
follows:

 

Provider Manual: refers to the manual(s) developed by Blue Shield dated
January 2002 and subsequent revised versions, which set forth the
operational rules and procedures applicable to the Group and Group
Providers.  The Provider Manual will
include the HMO Provider Manual, the HMO Benefit Guidelines and the Blue Shield
Medical Policy Manual.  The manual(s)
have been given to the Group and are incorporated into this Agreement by
reference.  Subsequent revised versions
will be provided to Group and are incorporated into this Agreement by reference.

 

Section 2.1 Capitated Professional Services is amended in full
to read as follows:

 

Capitated Professional Services. 
Group shall provide or arrange for the provision of all Medically
Necessary Capitated Professional Services to Members and shall be fully
financially responsible for those services as outlined in Exhibit B as Group
responsibility.  Such services shall be provided
or arranged through Group Providers who have been credentialed as required by
this Agreement and as more fully described in the Provider Manual.  Without limiting the foregoing, Group shall:
(i) be financially responsible for In-Area Emergency Services, and
Urgent Care Services provided by healthcare providers in addition to Group
Providers, as set forth in Exhibit B., (ii) refer Members, at Group’s cost and
when Group Providers are not available to provide Medically Necessary Capitated
Services, to non-Group Providers; (iii) provide all preventive health services
to which a Member is entitled under his/her Benefit Plan; and, (iv) make
available to Members those health education programs routinely provided by
Group and Group Providers at no charge to their patients.

 

Section 2.2 (b) Referrals For Other Covered Services is amended
in full to read as follows:

 

Group shall utilize the organ transplant provider network established
by Blue Shield for the provision of selected organ transplants.  Blue Shield shall, from time to time,
designate which transplant centers are to be utilized for specified transplants
and will communicate any changes to the Group prior to the effective date of
the change.

 

1

 

Section 2.3 (a), 2.3 (b), 2.3 (c), and 2.3 (d) Availability is
amended in full to read as follows:

 

(a) Group shall ensure that routine Capitated Professional Services
shall be available to Members during normal physician business hours
(generally, Monday through Friday, 9:00 a.m. to 5:00 p.m.) and Emergency
Services and telephone advice and referral shall be available, as Medically
Necessary, twenty-four (24) hours per day, seven (7) days per week, three
hundred sixty five (365) days per year. 
Appointment, scheduling, and office waiting times shall be within the
applicable guidelines set forth in the Provider Manual, NCQA standards, and
state or federal law.  Capitated
Professional Services shall at all times during the term of this Agreement be
made readily available through PCP facilities located in the zip code areas set
forth in Exhibit A.

 

(b) Group shall require that each Group Physician maintain
adequate on-call coverage arrangements with another Group Physician to provide
coverage for members when that Group Physician is temporarily unavailable.  The provision of services to Members by the
on-call Group Physician shall be governed by the terms of this Agreement.

 

(c) Group and Group Providers shall participate in all Benefit Programs
set forth in Exhibit A.  Except for
those PCP’s who generally only serve, or generally do not serve, geriatric
patients in their practices, or pediatricians who serve only pediatric
patients, or OB/GYN’s who serve only female patients, Group shall require
that each of its PCP’s accepts all of the Members who select them during such
times that such PCP’s practice is open to new patients.

 

(d) Group shall ensure that at any given time, the practices of an
adequate number of its PCPs are open to Members to meet all access standards
required by Blue Shield, and its regulatory agencies.  Each PCP, whether or not his/her practice is closed to new
patients, shall accept each Member (and such Member’s immediate family members)
who is or had been a patient of PCP at anytime during the two (2) years
immediately prior to such Member selecting physician as his/her PCP.  Without limiting the foregoing, Group shall
ensure that at anytime that a PCP is accepting new patients of other health
care service plans, such PCP accepts Members hereunder.  In the event a PCP, during the term of this
Agreement, elects to close his/her practice to new Members, Group shall give
Blue Shield sixty (60) days prior written notice of such closure or notice
as soon as Group becomes aware of the closure.  In the event a PCP, during the term of this Agreement, ceases to
be a Group Provider, Group shall give Blue Shield sixty (60) days prior written
notice of such closure.

 

Sections 2.4(b), 2.4(c), and 2.4(d) are amended in full to read as
follows:

 

(b) To assist Group in meeting Blue Shield requirements hereunder,
Group shall, through a duly designated representative, use best efforts to
attend occasional provider education/orientation sessions conducted by Blue
Shield.

 

(c) In providing Capitated Professional Services hereunder, Group shall
utilize only Group Providers who are credentialed and re-credentialed in
accordance with Blue Shield’s standards as set forth in the Provider Manual,
unless the Medically necessary service is not available from a Group
Provider.  Group and/or each Group
Provider shall provide to Blue Shield, on request, credentialing information in
such form as reasonably required by Blue Shield, NCQA standards, and state
and federal law.

 

(d) Group represents and requires that during the term of this
Agreement, each physician through whom it will provide Capitated Professional
Services hereunder shall: (i) maintain a current, unrestricted license to
practice medicine in California; and, (ii) maintain such staff privileges with
at least one Blue Shield Hospital as necessary for physician to provide
services to Members hereunder; and, (iii) be certified and eligible to
participate in the Medicare Program. 
Group further represents and requires that: (iv) each

 

2

 

non-physician Group Provider shall maintain a current and unrestricted
license to practice his/her profession or provide the contracted service; and,
(v) use of any physician extender shall be in strict compliance with the rules
of the California Medical Board.

 

Section 2.6 Group Service Contracts is amended in full to read
as follows:

 

Group shall provide to Blue Shield a written list of its Group
Providers, and each month notify Blue Shield of any additions or deletions to
such list (including any notices of termination of Group Providers), in
addition to which Group shall provide Blue Shield with immediate notice of
termination of Group Providers. 
Further, Group shall provide timely response to reasonable periodic written
requests from Blue Shield for verification of the current list of Group
Providers.  Group’s contracts with Group
Providers shall be in writing and shall require that such providers: (a)
seek payment for the provided services only from Group and under no
circumstances seek payment from the Member or from Blue Shield; (b) under no
circumstances balance bill or surcharge Members for Covered Services (including
in the event of Group and/or Blue Shield’s insolvency); (c) maintain and
disclose such records to Blue Shield and to Governmental Officials as set forth
in Article IX hereof; (d) permit Government Officials and Blue Shield to inspect
its offices, records, and facilities as set forth in Article X; (e) cooperate
with and participate in Blue Shield’s and Group’s quality improvement and
utilization management programs and Member grievance and appeal procedures;
and, (f) maintain such professional and general business liability insurance as
set forth in Article VIII hereof.  Upon
Blue Shield’s written request, Group’s form of provider contract(s),
along with the executed signature pages to such contracts, shall be provided to
Blue Shield.  Group may maintain the
confidentiality of its payment rates (other than bonus/withhold/shared risk or
savings arrangements), provided that such does not result in concealment or
misunderstanding of other terms and provisions of the contract.  Upon Blue Shield’s written request, such
contracts shall be promptly amended to contain any provisions required to be
contained in provider contracts by either the Department of Managed Health
Care (“DMHC”), CMS, or any other governmental agency.

 

Sections 2.9(a) and 2.9(b) Outpatient Drug Formulary and Pharmacy
Information are amended to read in full as follows:

 

(a) Group and Group Providers shall comply with the outpatient drug
formulary, drug prior authorization requirements, and pharmacy benefit design
(including maximum supplies, use of generics, and mail order for maintenance
drugs), as adopted and periodically modified by Blue Shield, as set forth in
the Provider Manual and as medically appropriate for the Member.

 

(b) In the event that Blue Shield provides to Group computerized or
electronic data regarding prescriptions obtained by Members and drugs supplied,
Group agrees that such information is provided for the limited and restricted
purpose of utilization management.  Under
no circumstances may Group copy or share such data with others, or utilize such
data, in whole or in part, directly or indirectly, to negotiate rebates,
discounts, or contracts with pharmaceutical manufacturers or other suppliers of
pharmaceuticals without the written approval of Blue Shield.

 

Section 2.11(a) Termination of Physician/Patient Relationship is
amended in full to read as follows:

 

Group or a Group Provider may terminate the professional relationship
with a Member only with Blue Shield’s consent which shall not be
unreasonably withheld and in accordance with the procedures set forth in
the Provider Manual.  In the event a
Group Provider terminates his/her relationship with a Member, Group shall
assist the Member in selecting another Group Provider for the provision of
Capitated Professional Services.

 

Sections 2.13(a) and 2.13 (b) Disclosures is amended in full to
read as follows:

 

3

 

(a) In addition to the notice obligation set forth in Paragraph 2.5,
Group shall notify Blue Shield immediately in writing when it becomes aware of
the occurrence of any of the following events: (i) Group’s or a Group
Provider’s liability insurance is canceled, terminated, not renewed, or
materially modified; (ii) Group or a Group Provider has become a defendant in a
lawsuit filed by a Member or is required or agrees to pay damages to a Member
for any reason; (iii) an act of nature or any event occurs which has a
materially adverse effect on Group’s ability to perform its obligations
hereunder; (iv) a petition is filed to declare Group bankrupt or for
reorganization under the bankruptcy laws of the United States or a receiver is
appointed over all or any portion of the Group’s assets; or (v) Group is sued
by a healthcare provider for nonpayment of compensation; or (vi) any other
situation arises which could reasonably be expected to materially affect
Group’s ability to carry out its obligations under this Agreement.  Group shall also provide Plan with thirty
days’ advance notice of any proposed material change in the ownership of Group,
a change in its management services organization (if any), or the sale of all
or substantially all of the assets of the Group.

 

(b) Annually, within sixty (60) days following the end of Group’s
fiscal year or thirty days following such information being available to Group,
Group shall provide to Blue Shield access to its most recent annual
income statement, balance sheet, and statement of cash flow, which shall be
prepared in accordance with generally accepted accounting principles and shall
be certified by Group’s chief executive officer or chief financial
officer.  Group shall provide access
to any audited financial statements it may have to Blue Shield.  A narrative or work sheet describing the
calculation of Group’s IBNR shall accompany the   financial statements. 
The information set forth in this paragraph shall also be provided by
Group to Blue Shield in the event there is an actual or proposed change in
ownership of Group.  Group shall also,
upon written request, provide Blue Shield with access to
quarterly financial statements, which shall include a balance sheet, statement
of income and statement of cash flow prepared in accordance with generally
accepted accounting principles.

 

Section 2.16 Acceptance of Members is amended in full to read as
follows:

 

Group shall accept all Members who select or who are assigned to Group
or Group PCP’s, if the practice is open to new Members, who live or work
within the Group Service Area.  This
requirement shall not apply to Members with whom the Group’s relationship was
terminated in accordance with section 2.11 hereof.  Blue Shield shall undertake reasonable efforts in accordance with
a standard of good faith to assure that Members who select or are assigned to
Group or Group PCPs live or work within the Group Service Area.

 

Section 3.2 (a) Failure To Make Payment is amended in full to
read as follows:

 

(a) In the event that Group occasionally fails to pay a Group Provider
or other healthcare provider for Capitated Professional Services within the
time frames set forth in this Agreement, and Blue Shield reasonably determines
that such amount is due and payable by Group, Blue Shield may, after notice to
Group, and reasonable opportunity for Group to pay, pay the amount due,
and deduct and offset such payment from any amount then or thereafter payable
by Blue Shield to Group.

 

Sections 4.3(a) Termination of Delegation are amended in full to
read as follows:

 

In the event that Blue Shield is dissatisfied for any reason with
Group’s performance of delegated activities, Blue Shield may, after due
diligence and informal attempt to correct the problems, in its sole
discretion, modify Group’s status (with respect to all or a particular
delegated activity) from fully delegated to delegated with corrective
action.  Such notice of delegation with
corrective action shall set forth the deficiencies perceived by Blue Shield in
Group’s performance of delegated activities, and Group shall have ninety (90)
days to correct such deficiencies to the reasonable satisfaction of Blue
Shield.  In

 

4

 

the event such deficiencies are not corrected to the reasonable
satisfaction of Blue Shield, Blue Shield may, in its sole discretion, terminate
the delegation or extend the period given Group to correct such deficiencies.

 

Section 5.2 Provider Manual is amended in full to read as
follows:

 

Provider Manual.  Blue Shield
shall develop a Provider Manual, and Group and Group Providers shall comply
with its provisions, which shall be communicated to Group.  Blue Shield may, in its discretion,
periodically modify the Provider Manual by written notice to Group.  The Provider Manual, as so amended, is
incorporated herein by reference.  To
the extent of any conflict between this Agreement and the Provider Manual, the
terms of this Agreement shall govern. 
In the event Group reasonably concludes that a change in the Provider
Manual would have an adverse financial impact on the Group, then Group and Blue
Shield shall confer in good faith regarding the change.  See Section 7.12 Material Change of
Circumstances.

 

Section 5.3 Blue Shield Reports is amended in full to read as
follows:

 

Blue Shield Reports.  Blue
Shield shall provide to Group such reports regarding utilization and other matters
as set forth in the Provider Manual

 

Sections 6.3(a) Eligibility List and Modifications are amended
in full to read as follows:

 

Blue Shield shall provide to Group on a monthly basis within ten days
of the start of the month, a member eligibility report and a member eligibility
change report, as further described in the Provider Manual.  These reports shall be submitted to the
Group electronically, unless both Blue Shield and the Group agree that it may
be submitted in writing.  Blue Shield
shall attempt to discourage retroactive cancellation or retroactive addition of
Members.  However, Blue Shield may make
exceptions as may be necessary for administrative or business reasons.  Subsequent Capitation to Group will be
adjusted to reflect the retroactive addition or deletion of Members.  With the exception of retroactive changes
for Members in Blue Shield 65 Plus and those Members enrolled through CalPERS
and FEHBP, retroactive additions or deletions shall not exceed ninety (90)
days.  For those members enrolled
through CalPERS and FEHBP, retroactive additions or deletions shall not exceed
the limitation on retroactive additions and deletions that Blue Shield has in
place with CalPERS and FEHBP.

 

Section 7.3 Copayments is amended in full to read as follows:

 

Group shall collect and retain, as additional compensation, the
Member’s applicable Copayment for Covered Services provided.  Such Copayment obligation shall not be
waived by Group or Group Providers on a regular or routine basis but may be
waived on a case-by-case basis in the event of a financial hardship on the part
of the member.

 

Section 7.4 Stop Loss Coverage is amended in full to read as
follows:

 

During the term of this Agreement, Group shall either obtain
professional stop loss coverage through Blue Shield under the terms and
conditions set forth in Exhibit H attached hereto or shall obtain professional
stop loss coverage from a third party insurer, which shall be communicated
to Blue Shield.  Upon request,
certificates and other proof of such coverage shall be provided to Blue
Shield.  Group shall provide Blue Shield
with timely notice of cancellation of coverage or change in carrier.  If Group elects to have Blue Shield provide
such stop loss coverage, by so indicating on the Signature Page hereto, Blue
Shield shall provide and charge Group for stop loss coverage as set forth in
Exhibit H.

 

5

 

Section 7.12 Material Change of Circumstances is added in its
entirety as follows:

 

Material Change of Circumstances:  In the event of a Material Change, as
defined, during the term of this Agreement, and upon written request from
either party, Blue Shield and Group agree to meet to discuss in good faith the
impact of the Material Change on the financial relationship between the
parties.  If, within sixty (60) days
following the date of such request, the parties are unable to reach agreement
on the extent of financial impact of the Material Change, or the appropriate
change, up or down, in the amount of Capitation (Exhibit C.), the terms of the
Shared Savings program (Exhibit D.) or the Division of Financial Responsibility
(Exhibit B.), then the matter shall be sent to a mutually acceptable
independent actuary not affiliated with either party who will make such a
determination.  The cost of the
independent actuary shall be borne equally by the parties.  The determination of the independent actuary
shall be binding upon the parties unless either party, within thirty (30) days
of receipt of the actuary’s determination, files a Demand for Arbitration
pursuant to Section 11.2 hereof.  For
purposes of this section, “Material Change” shall include, but, not be limited
to, the following which results in a material change in cost to Group (an
increase or a decrease) or has a material impact on the risk relationship
between Blue Shield and Group: (i) a change in the type, scope or duration of
Covered Services mandated by legislation, regulations or a regulatory agency,
(ii) the addition or removal by Blue Shield of a service from the list of
Capitated Professional Services set forth in Exhibit B., (iii) the addition or
removal by Blue Shield of a service from the list of Shared Savings services
set forth in Exhibit B., (iv) the development of new technology, therapies or
pharmaceuticals or a change in Blue Shield Medical Policy which results in a
material change in costs over the cost of existing approved treatment for the
same condition (an increase or a decrease), or, (v) enactment of any statute or
regulations which otherwise results in a material change in cost to Group (an
increase or a decrease) or has a material impact on the risk relationship
between Blue Shield and Group.  A change
or collection of changes will not be considered to be “Material” unless the
aggregate net change in cost to Group (increase or decrease) is thirty cents
(30 cents) or more per member per month.

 

Section 8.6 Member Complaints and Grievances is amended in full
to read as follows:

 

Member Complaints and Grievances. 
Group shall promptly notify Blue Shield of receipt of any claims,
including professional liability claims filed or asserted by a Member against
Group or a Group Provider.  Group shall
cooperate with Blue Shield in identifying, processing, and resolving all Member
grievances and other complaints, in accordance with Blue Shield’s
complaint/grievance process and time limits set forth in the Provider Manual,
as well as in accordance with such time limits as required by state and/or
federal law.  Group shall comply with
Blue Shield’s resolution of any such complaints or grievances including
specific findings, conclusions and orders of the Department of Managed
Health Care.

 

Section 8.9(a) Insurance is amended in full to read as follows:

 

Group and Group Providers shall maintain professional liability
(malpractice) insurance coverage in the minimum amount of One Million Dollars
($1,000,000) per occurrence and Three Million Dollars ($3,000,000) annual
aggregate per physician per year for all physicians who are partners,
associates or employees of Group and warrants that all physicians with which
Group contracts will carry professional liability coverage in the same
amount.  Group and Group Providers
shall maintain general liability insurance coverage in the minimum amount of
One Million Dollars ($1,000,000) per occurrence for all business activities.  If Group or its Group Providers or
subcontracts have a claims-made malpractice insurance policy, then they agree
to keep the policy in effect for at least five (5) years past any termination
of this Agreement or purchase extended reporting coverage (tail insurance).

 

Section 9.1 Medical Records is amended in full to read as
follows:

 

6

 

Group and Group Providers shall maintain the usual and customary records
for Members in the same manner as for other patients of Group and Group
Providers.  Group will require that all
Group Physicians establish and maintain in an accurate and timely manner for
each Member who has obtained care from such physician a medical record which is
organized in a manner which contains such demographic and clinical information
as is necessary, according to standards set forth by state, federal, and
accreditation agencies, to provide documentation as to the medical problems
and medical services provided to the Member. 
Such record shall include a historical record of diagnostic and
therapeutic services recommended or provided by, or under the direction of, the
provider.  Such records shall be in such
a form as to allow trained health professionals, other than the provider, to
readily determine the nature and extent of the Member’s medical problem and the
services provided and permit peer review of the care provided.  Such records shall, on request, and within
reasonable time requirements, be made available without charge to Blue Shield
and its designated agents.  Without
limiting the foregoing, Group shall, without charge, transmit Member’s medical
records information to a Member’s other providers, to Government Officials, and
to Blue Shield for purposes of utilization management, quality improvement and
other Blue Shield for purposes of utilization management, quality improvement
and other Blue Shield administrative purposes. 
Upon termination of this Agreement, or the re-assignment or transfer of
Members, one copy of such records shall be provided without charge to the
Member’s new medical group upon request.

 

Sections 10.1 (c) and 10.1 (d) Disclosure of Records is amended
to read in full as follows:

 

(c ) Upon forty-eight (48) hours written notice, Group shall
make any records of its quality improvement and utilization review activities
pertaining to Members and provider credentialing files available to Blue
Shield’s quality and utilization review committee.  Such sharing of records between the two committees shall be in
accordance with, and limited to, Sections 1157 of the California Evidence Code
and 1370 of the California Health and Safety Code and shall not be construed as
a waiver of any rights or privileges conferred on either party by those
statutes.

 

(d) Blue Shield, at its sole cost and expense, and with reasonable
prior written notice to Group, may from time to time audit the books and
records of Group as they relate to its services, claims payments, authorization
turn-around times, reporting, and billings under this Agreement.

 

Sections 10.2 Site Evaluations is amended in full to read as
follows:

 

Group and Group Providers shall permit Government Officials and Blue
Shield to conduct periodic site evaluations and inspections of their facilities
and records.  In the event that
Government Officials or Blue Shield find any deficiencies in such facilities or
records, Group, or Group Provider, as applicable, shall have thirty (30) business
days to substantially correct such deficiencies which are identified by such
Government Officials or Blue Shield.

 

Section 11.2 Arbitration of Disputes is amended in full to read
as follows:

 

If any dispute, controversy, or misunderstanding (other than a claim of
medical malpractice) arises between the parties to this Agreement which exceeds
the jurisdiction of Small Claims Court, which was not resolved in the Provider
Dispute Resolution procedure set forth in Paragraph 11.1, and which may
directly or indirectly concern or involve any term, covenant, or condition
hereof, the parties shall settle the dispute by final and binding arbitration
in Los Angeles, California, Arbitration shall be conducted under the Commercial
Rules of the American Arbitration Association. 
The arbitration decision shall be binding on both parties.  It is agreed that the arbitrator shall be
bound by applicable state and federal law and that the arbitrator shall issue
written findings of fact and conclusions of law.  The arbitrator shall have no authority to award damages

 

7

 

or provide a remedy which would not be available to such prevailing
party in a court of law nor shall the arbitrator have the authority to award
punitive damages.  The cost of the
arbitration shall be shared equally by Group and Plan.  Each party shall be responsible for its own
attorneys’ fees.

 

Section 12.1 Term is amended in full to read as follows:

 

Term.  When executed by both
parties, this Agreement shall become effective as of the Effective Date, and
shall continue in effect for two (2) years thereafter, unless earlier
terminated as set forth below.  Unless
either party notifies the other party at least one hundred twenty (120)
calendar days prior to the expiration of said initial two year term, this
Agreement shall, following termination of the initial term, continue in effect
for additional one (1) year terms until terminated as set forth below.

 

Section 12.2 Termination Without Cause is amended in full to
read as follows:

 

Either party may terminate this Agreement at anytime without cause by
giving to the other party at least one hundred twenty (120) calendar days
written notice of termination.  The
termination shall become effective the first day of the month following the
expiration of the notice period.

 

Section 12.6 (b) Effect of Termination is amended in full to
read as follows:

 

Group shall, at Blue Shield’s option, continue rendering Capitated
Professional Services after the termination of this Agreement to Members
assigned to Group at the Blue Shield Allowable Rates noted in Exhibit E,
for the duration of the contracts in effect with Blue Shield through which
Members are enrolled with Blue Shield, or until such time as Blue Shield has
arranged for an alternative source of services for each such Member from other
contracting providers, but not to exceed ninety (90) days.

 

Section 13.7 Financial Solvency Reporting is amended in full to
read as follows:

 

The Group shall comply with any and all applicable reporting
requirements set forth in the Knox-Keene Act and regulations.

 

Section 13.8 Blue Shield Reporting Requirements is amended in
full to read as follows:

 

Blue Shield shall submit Quarterly and Annual reports to the Department
of Managed Health Care in compliance with the legal requirements of state
law.

 

Section 14.3 Entire Agreement is amended in full to read as
follows:

 

Entire Agreement.  This Agreement, all attachments and Exhibits
referenced in this Agreement and attached hereto, and the Provider Manual, as
amended from time to time, are incorporated herein by reference, and constitute
the entire understanding between the parties relating to the subject matter
hereof.  This Agreement does not
supersede or modify any agreement between the parties pertaining to Blue
Shield’s PPO Benefit Programs, including without limitation, any Physician
Member Application and Agreement between the parties or between Blue Shield and
Group physicians.  See Section 7.12
Material Change of Circumstances.

 

Sections 14.5 Notices is amended in full to read as follows:

 

Any notices or other communication made or contemplated by this
Agreement to be in writing shall be deemed to have been received by the party
to whom it is addressed three (3) business days after it is deposited in
the United States mail, certified postage prepaid, return receipt requested, or
the date of delivery by Federal Express or similar commercial courier service,
and addressed as set forth in Exhibit A., or to such other

 

8

 

address as either party from time to time informs the other in
writing.  Further, notice may be given
during normal business hours by facsimile transmission to the number set forth
in Exhibit A, which shall be deemed received upon facsimile transmission
confirmation, or by personal delivery to the address set forth in Exhibit A,
which shall be deemed received upon receipt of a signature from the person or
office at the designated address.

 

Section 14.7(b) Assignment, Subcontracting, and Additions of PCPs
is amended in full to read as follows:

 

For purposes of providing services to Members hereunder, Group may not
add as PCPs any physician to the Blue Shield network whose principal
medical office is located outside the postal zip codes set forth as PCP Zip
Codes in Exhibit A., without Blue Shield’s prior written consent, which consent
will not be unreasonably withheld.

 

Sections 14.9 Confidentiality/Trade Secrets is amended in full
to read as follows:

 

The compensation terms of this Agreement and all terms relating to
compensation shall be confidential. 
Group shall not disclose such terms (other than to Government Officials and
appropriate business professionals who work with the Medical Group, such as
accountants, lawyers and consultants), except with the prior written
consent of Blue Shield.  However,
nothing herein shall prohibit Group or Group Providers from disclosing to
Members and others the method by which they are compensated (e.g., capitation,
fee-for-service, etc.); it is the precise compensation amounts for which
confidential treatment is required by this provision.

 

Sections 14.10 Non-Solicitation is amended in full to read as
follows:

 

During the term of this Agreement, and for six (6) months
thereafter, neither Group nor Group Providers shall solicit, induce, or
encourage any Member to disenroll from Blue Shield or select another health
care service plan for healthcare services. 
Notwithstanding the foregoing, Group and Group Providers shall be
entitled to freely communicate with Members regarding any aspect of their health
status or treatment.

 

All other conditions and terms of this Agreement shall remain the
same.  When executed by both parties,
this Amendment shall be effective as of February 1, 2003.

 

	
  BLUE SHIELD OF CALIFORNIA

  	
  NORTHWEST ORANGE COUNTY MEDICAL
  GROUP

  
	
   

  
	
   

  
	
  By:

  	
  /s/ Lisa Farnan

  	
   

  	
  By:

  	
  /s/ Pratibha Patel

  	
   

  
	
   

  	
  LISA FARNAN

  	
   

  	
  PRATIBHA PATEL, MD

  
	
   

  
	
   

  
	
  Title:

  	
  VP, PROVIDER RELATIONS

  	
   

  	
  Title:

  	
  PRESIDENT

  	
   

  
	
   

  
	
  Date:

  	
  3-21-03

  	
   

  	
  Date:

  	
  3/12/03

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  By:

  	
  /s/ James P. Aronick

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  JAMES P. ARONICK

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Title:

  	
  CEO

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Date:

  	
  3/12/03

  	
   

  
							

 

9

 

AMENDMENT
NO. XV

 

AMENDMENT
TO

BLUE SHIELD OF CALIFORNIA

HMO FULL SERVICE IPA AGREEMENT

 

The HMO Full Service IPA Agreement (hereinafter “Agreement”) between
California Physicians’ Services, Inc. d.b.a. Blue
Shield of California (hereinafter “Blue Shield”) and North West Orange County Medical Group
(hereinafter “IPA”) with an effective date of September
1, 1998 is further amended as follows:

 

Recitals

 

A.            Whereas, La Palma
Intercommunity Hospital Medical Center terminated their Capitated Hospital
Agreement with Blue Shield, effective January 1, 2003, for Commercial members
assigned to IPA and to La Palma Intercommunity Hospital Medical Center as their
primary hospital;

 

NOW, THEREFORE, in consideration of the recitals above and of the
intention of both parties to amend the Agreement to reflect a change in certain
terms, the Agreement is hereby amended as follows:

 

1.             The attached Exhibit
H Shared Savings Programs is added in its entirely;

 

2.             Exhibit H will be
effective January 1, 2003 for Commercial members assigned to IPA, who utilize
La Palma Intercommunity Hospital Medical Center as their primary hospital (“La
Palma Pod”).

 

All other terms and conditions of this Agreement shall remain the same.

 

	
  BLUE SHIELD OF CALIFORNIA

  	
  NORTHWEST
  ORANGE COUNTY

  MEDICAL GROUP

  
	
   

  
	
   

  
	
  By:

  	
  /s/ Lisa Farnan

  	
   

  	
  By:

  	
  /s/ Pratibha Patel

  	
   

  
	
   

  	
  Lisa Farnan

  	
   

  	
  PRATIBHA PATEL, MD

  
	
   

  
	
   

  
	
  Title:

  	
  V.P., Provider Relations

  	
   

  	
  Title:

  	
  PRESIDENT

  	
   

  
	
   

  
	
  Date:

  	
  3-21-03

  	
   

  	
  Date:

  	
  3/12/03

  	
   

  
	
   

  
	
   

  	
   

  	
   

  	
  By:

  	
  /s/ James P. Aronick

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  JAMES P. ARONICK

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Title:

  	
  CEO

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Date:

  	
  3/12/03

  	
   

  
												

 

1

 

EXHIBIT
H

 

HMO Full
Service Medical Group Agreement

 

SHARED
SAVINGS PROGRAM

 

NORTHWEST
ORANGE COUNTY MEDICAL GROUP

 

Effective
Date: January 1, 2003 (La Palma Pod)

 

COMMERCIAL MEMBERS

 

FUNDING: For Members other than those enrolled in Blue Shield 65 Plus
plans and Blue Shield POS Benefit Programs, Blue Shield will allocate to a
Shared Savings Fund a per Member per month amount set forth in Exhibit H- l for
all Members assigned to Group, subject to retroactive adjustments either upward
or downward due to retroactive changes in membership.

 

CHARGING OF PAYMENTS: Blue Shield shall charge against the Shared
Savings Fund all payments made by Blue Shield for such Members during the
annual term of the Agreement which are designated as Hospital responsibility
under Schedule A-1, Division of Financial
Responsibility Matrix, less payments received by Blue Shield as a
result of third-party reimbursement, Workers’ Compensation recoveries and
coordination of benefits payments.  Blue
Shield shall include any payments for Shared Savings Services which are paid prior
to the date of the settlement, as well as a reasonable allowance, as determined
by Blue Shield’s actuaries, for incurred but not paid (IBNP) claims.  Any costs for Shared Savings Services not
included in any annual settlement shall be carried forward and included in the
Shared Savings settlement for the succeeding Agreement Year.  In addition, if this Agreement is replaced
or superceded any other agreement between the parties which contained a risk
sharing arrangement for similar services; then the following shall also be
charged against the Shared Savings Fund described herein: (i) any deficit in
the final settlement of that risk sharing arrangement and, (ii) any claims for
risk services which were incurred but not included in the settlement of the
risk arrangement in the prior agreement.

 

SHARED SAVINGS FUND SETTLEMENT: The Shared Savings Fund shall be
settled on an annual basis, within one hundred eighty (180) days following the
end of each annual term of the Agreement (being a 120 day claims run out and a
60 day determination period).  In the
event of termination of the Agreement for any reason, final settlement of the
Shared Savings Fund shall be performed one hundred fifty (150) days after the
date of termination and any amounts due from Blue Shield to Group shall be paid
within thirty (30) days thereafter.

 

Surplus:
If the total actual cost of Shared Savings Services is less than the total
allocation to the Shared Savings Fund, then Group shall be entitled to fifty
percent (50%) of the amount by which the allocation exceeds the costs, not to
exceed thirty-five percent (35%) of HMO Capitation Fees, minus any carry
forward resulting from deficits from previous Agreement years.

 

Deficit: If the total actual cost of Shared Savings
services is more than the total allocation to the Shared Savings Fund, then
fifty percent (50%) of the amount by which the actual costs exceed the total
allocation, not to exceed five percent (5%) of the HMO Capitation Fees, shall
be allocated to Group and shall be handled as follows: (i) the excess may be
deducted from any other settlements or payments, except capitation and
Professional Stop Loss Program payments made pursuant to Exhibit H, due to
Group from Blue Shield, and, (ii) any remaining amounts shall be carried
forward into future Agreement years and shall be deducted from any Shared
Savings payments to Group in future years.

 

SUMMARIES & SETTLEMENTS: Blue Shield shall provide to Group a
Shared Savings Program quarterly Report and a Shared Savings Annual Settlement,
as further described in the Provider Manual.

 

2

 

EXHIBIT
H-1

 

HMO
IPA/MEDICAL GROUP AGREEMENT

 

Shared
Savings Fund Allocation for NorthWest Orange County Medical Group

 

Effective
Date: 01/01/03

 

As of
01/01/2003, the effective net yield (which includes the deduction for Stop
Loss, if applicable) for the following PMPMs are *** for the HMO Group, *** for
the HMO IFP, and *** for the HMO PERS based on the 07/01/2002 membership.

 

The
actual allocation to Shared Saving fund for each month will be calculated based
on the actual member mix for each age/sex category.

 

Members
Other Than Blue Shield 65 Plus Members

 

Age
& Sex Categories and Shared Savings Allocations

 

	
  Category

  	
   

  	
  Shared
  Savings Allocation (PMPM)

  
	
  Sex

  	
   

  	
  Age

  	
   

  	
  Group

  (non-POS)

  	
   

  	
  IFP

  (non-POS)

  	
   

  	
  PERS

  (non-POS)

  
	
  F

  	
   

  	
  0 - 1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  F

  	
   

  	
  65 + (M) *

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  M

  	
   

  	
  0 - 1

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  2 - 6

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  7 - 18

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  19 - 21

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  22 - 24

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  25 - 29

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  30 - 34

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  35 - 39

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  40 - 44

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  45 - 49

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  50 - 54

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  55 - 59

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  60 - 64

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  65 + (NM)

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  M

  	
   

  	
  65 + (M) *

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  

 

* - Medicare Primary

*** All references to the Shared
Saving Fund Allocation have been deleted.

 

3

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00067-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00067-of-00352.parquet"}]]