Capitation Rates

Capitation rates are member-based and adjusted by age, gender and plan type. If a member has a non-standard effective or cancel date, the capitation rate is prorated by the actual number of days the member is active.

In addition, premiums for professional stop loss levels, withhold funds, AIDS, transplant reinsurance costs, and transfer reinsurance costs can be subtracted from the capitation rate.

Premiums are subtracted from the institutional capitation rate for in-area and out-of-area reinsurance costs if purchased from Health Net.