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2014-318 HR - UnitedHealthCare for United HealthCare Application for Excess Loss Insurance Policy $1,625,322
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2014-318 HR - UnitedHealthCare for United HealthCare Application for Excess Loss Insurance Policy $1,625,322
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Last modified
5/16/2017 3:32:16 PM
Creation date
8/8/2014 11:38:20 AM
Metadata
Fields
Template:
BOCC
Date
9/17/2013
Meeting Type
Regular Meeting
Document Type
Others
Agenda Item
09/17/2013
Amount
$1,625,322.00
Document Relationships
2015-141-E County Manager - UnitedHealthCare of NC - Amendment to Excess Loss Insurance Policy $635,758
(Linked From)
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\Board of County Commissioners\Contracts and Agreements\General Contracts and Agreements\2010's\2015
R 2014-318 HR - UnitedHealthCare for application for Excess Loss Insurance Policy
(Linked To)
Path:
\Board of County Commissioners\Contracts and Agreements\Contract Routing Sheets\Routing Sheets\2014
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EXHIBIT B-SERVICE FEES <br /> This exhibit lists the service fees Customer must pay United for its services during the term of the Agreement. These <br /> fees apply for the period from January 1,2014 through December 31,2014.Customer acknowledges that the amounts <br /> paid for administrative services are reasonable. <br /> Administrative Service Fees—Standard Medical Service Fees <br /> The Standard Medical Service Fees described below, excluding optional and non-standard fees, are adjusted as set <br /> forth in the applicable performance standard(s). <br /> The Standard Medical Fees listed below are based upon an estimated minimum of 995 enrolled Employees. <br /> The Standard Medical Service Fees are the sum of the following: <br /> January 1,2014 through December 31,2014 <br /> • $38.35 per Employee per month covered under the Choice Plus portion of the Plan. <br /> Average Contract Size: 1.66. <br /> Pharmacy AWP Contract Rate <br /> Customer's contract rate for prescription drugs is as provided in Exhibit C. United uses Medi-Span's national drag <br /> data file as the source for average wholesale price (AWP) information. United reserves the right to revise the <br /> pricing and adopt a new source or benchmark if there are material industry changes in pricing methodologies. <br /> Administrative Service Fees-Non-Standard Fees <br /> Service Description Fee <br /> Fraud and Abuse Management Fee equal to thirty-two and five-tenths percent(32.5%)of <br /> the gross recovery amount <br /> Hospital Audit Program Services Fee not to exceed thirty-one percent(31%)of the gross <br /> recovery amount <br /> Credit Balance Recovery Services Fee not to exceed ten percent(10%)of the gross recovery <br /> amount. <br /> Standardized Summary of Benefits and Coverage(SBC)as United will provide,at no additional charge,standard <br /> established under The Patient Protection and Affordable Care format,electronic copies of the SBC documents(twice per <br /> Act of 2010 year)for medical benefit plans administered by United. <br /> Customer logos can be included on the SBC at no <br /> additional charge. Additional fees will apply for other <br /> services. United will not create SBCs for medical plans it <br /> does not administer. <br /> Third Party Liability Recovery(Subrogation)Services Fee equal to thirty-three and one-third percent(33.3%)of <br /> the gross recovery amount <br /> Advanced Analytics and Recovery Services Fee equal to twenty four percent(24%)of the gross <br /> -recovery amount <br /> Shared Savings Program Customer will pay a fee equal to thirty-five percent(35%) <br /> of the"Savings Obtained"as a result of the Shared Savings <br /> Program. "Savings Obtained"means the amount that would <br /> have been payable to a health care provider,including <br /> amounts payable by both the Participant and the Plan,if no <br /> discount were available,minus the amount that is payable <br /> to the health care provider,again,including amounts <br /> payable by both the Participant and the Plan,after the <br /> discount is taken. <br /> External Reviews For each subsequent external review beyond 5 total <br /> reviews per year,a fee of$500 will apply er review. <br /> 22 <br />
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