Member Types

This page is referenced in, and incorporated by reference into, the Navina Products and Services Schedule (the
“Schedule”). It sets out the Member types supported by Navina, as updated by Navina from time to time. The
plans, and the Member types eligible under a customer’s subscription, are as determined in the applicable
Order Form. Capitalized terms used but not defined on this page have the meanings given to them in the
Schedule, the Navina Master SaaS Agreement, or the applicable Order Form.

‍
“VBC Member” means a Member who is attributed to, aligned with, or under the responsibility of Customer or
an Affiliated Provider pursuant to a value-based, shared savings, capitated or otherwise risk-bearing
arrangement, including Medicare Advantage Members, Medicare ACO Members, and Medicaid Members and
Commercial Members covered under such arrangements.

‍
“Medicare Advantage Member” means an individual enrolled in a Medicare Advantage plan under Part C of
Title XVIII of the Social Security Act, including a Medicare Advantage special needs plan and a dual eligible
special needs plan (D-SNP), for whom Customer or an Affiliated Provider, whether directly or through a
contracted payer, provider network, management services organization or independent physician association,
performs or supports risk adjustment, quality reporting or care management functions.

‍
“Medicare ACO Member” means a Medicare fee-for-service beneficiary who is aligned, assigned or attributed
to Customer or an Affiliated Provider under an accountable care or total cost of care program, including the
Medicare Shared Savings Program (MSSP), ACO REACH and other models administered by the CMS
Innovation Center.

‍
“Medicaid Member” means an individual enrolled in a State Medicaid program, a Medicaid managed care plan
or the Children’s Health Insurance Program (CHIP), or who is dually eligible for Medicare and Medicaid other
than through a D-SNP, for whom Customer or an Affiliated Provider performs or supports risk adjustment,
quality reporting or care management functions.

‍
“Commercial Member” means an individual enrolled in a commercial or employer-sponsored health plan, or in
a qualified health plan offered through a Federally-facilitated or State-based health insurance marketplace
under the Affordable Care Act (an “ACA Member”), for whom Customer or an Affiliated Provider performs or
supports risk adjustment, quality reporting or care management functions.

‍
“Non-VBC Member” means any individual included within the scope of the Services who is not a VBC Member,
including an individual who is not attributed to Customer or an Affiliated Provider under any value-based, shared
savings, capitated or otherwise risk-bearing arrangement, a Medicare fee-for-service beneficiary who is not
aligned to an accountable care program, and a self-pay individual.

‍
“Pediatric Member” means a Member who is under eighteen (18) years of age, or such other age as is
specified in the Order Form, as of the applicable Assessment Date. A Pediatric Member may be included only
as a VBC Member other than a Medicare Advantage Member or a Medicare ACO Member, or as a Non-VBC
Member, and is subject to Section 2.6 (Pediatric Functionality) of the Schedule.

‍
Last updated: Sep 1st 2026