CareSource Indiana, Inc.

Executed amendment · executed

Healthy Indiana Plan Amendment #3 for CareSource Indiana, Inc.

FSSA Amendment #3 to contract 0000000000000000000069651 with CareSource Indiana, Inc. amends the Healthy Indiana Plan contract. It updates Exhibits 1.B, 2.B, 5.B, and 6.B. Exhibit 5.B, contract definitions, is superseded and replaced by Exhibit 5.C. Exhibit 6.B, the state's capitation rates, is superseded and replaced by Exhibit 6.C. Unless otherwise noted, this amendment is effective January 1, 2026. The cover does not state a new contract termination date. The underlying contract was approved by the last State signatory on February 21, 2023. That date is not a signature date for this amendment. The cover does not print a posted date or an amendment signature date. The instrument states a funding addition and a total remuneration cap. Those figures are not repeated here.

Publisher: Indiana Family and Social Services Administration. Program: Healthy Indiana Plan. Amendment number: 3. Contract number: 0000000000000000000069651. Document: 503Caresource23HIP-AM03-69561.pdf.

Supersession: Exhibit 6.B is superseded and replaced by Exhibit 6.C.

Named in the instrument:

• CareSource Indiana, Inc.

Source: FSSA Healthy Indiana Plan contract 69651 Amendment #3 (Amendment cover, page 1, confirmed 2026-11-05; evidence retrieved 2026-11-05). Source receipt: not checked.

this amendment shall be effective January 1, 2026.