Triple-s Management (GTS) 10-Q 2010 Q2 Quarterly report

Exhibit 10.3

2008-000065i

PHYSICAL HEALTH INSURANCE
CONTRACT

AGREEMENT BETWEEN

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

And

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

Contractor Name

For the Provision of Health Insurance

coverage to eligible population under the

Government Health Insurance Plan

WITNESSETH

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

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

WHEREAS: The Contract was extended by Amendment Number 08-065-H until June 30, 2010.

WHEREAS: The Board of Directors of theADMINISTRATIONdecided to extend the Contract until August 31, 2010 under the same terms and conditions of the Contract #08-065 and its amendments. Also, the premiums established for the period of January 1,2010 until June 30, 2010 remains unchanged. The premiums for the month of September 2010 are amended as provided for in Appendix C.

HENCEFORTH:The appearing Parties agree to amend the Contract #08-065 to extend the effective date and term until September 30, 2010, amend the Article VIII, Section 22 and the Appendix C. The Amendment reads as follows:

Article I:To amend the following language at the end of Article VIII, Section 22, to read as follows:

For the period of the contract, effective from July 1, 2010 through September 30, 2010, theADMINISTRATIONassures that it will provide an adequate stop-loss insurance set at six thousand dollars ($6,000.00).

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

1.	This contract amendment shall be in effect from July 1st, 2010 until September 30, 2010.
2.	.......
3.	.......

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Article III:To amend Appendix C, to incorporate the effective date of the premium rates for this contract period.

All other terms and conditions of the contract number 08-065; and its amendments 08-065A through 08-065H remain unchanged. In witness whereof, the parties have duly executed this Amendment on this 15 day of July, 2010 and affixes below their respective signature.

/s/ Domingo Nevárez Ramírez  

Domingo Nevárez Ramírez, MHSA 

Executive Director
Puerto Rico Health Insurance Administration 

/s/ Socorro Rivas  

SOCORRO RIVAS 

Chief Executive Officer
TRIPLE-S SALUD INC. 

/s/ Luis A. Marini  

LUIS A. MARINI, DMD 

Chief Executive Officer 

Cifra Cuenta 5000-212

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AppendixC

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

The monthly premiums for all beneficiaries, including all those who are sixty-five (65) years and older who are Medicare beneficiaries Part A or Part A and B those who are sixty-five years and older who are not Medicare recipients is established below on a per member per month (pmpm) rate; for the period of July 1^st, 2010 to August 31, 2010.

Monthly Premiums Rates

SSS

			Fixed Administrative
Region or Area	Premiums		Cost		Profit
North	$	87.99	$	6.30	$	2.20
Southwest	$	87.71	$	6.30	$	2.19

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

The monthly premiums for all beneficiaries, including all those who are sixty-five (65) years and older who are Medicare beneficiaries Part A or Part A and B those who are sixty-five years and older who are not Medicare recipients are established below on a per member per month (pmpm) rate; for the month of September 2010.

SSS

			Fixed Administrative
Region or Area	Premiums		Cost		Profit
North	$	93.54	$	6.08	$	0.94
Southwest	$	91.43	$	5.94	$	0.91

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