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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
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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
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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
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\Board of County Commissioners\Contracts and Agreements\Contract Routing Sheets\Routing Sheets\2014
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EXHIBIT C-PERFORMANCE STANDARDS FOR HEALTH BENEFITS <br /> The Standard Medical Service Fees (excluding Optional and Non-Standard Fees and that portion of the Standard <br /> Medical Service Fees attributable to Commission Funds, if applicable, as described in Exhibit B), (hereinafter <br /> referred to as "Fees") payable by Customer under this Agreement will be adjusted through a credit to its Service <br /> Fees in accordance with the performance guarantees set forth below unless otherwise defined in the guarantee. <br /> Unless otherwise specified, these guarantees apply to medical benefits and are effective for the period beginning <br /> January 1, 2014 and ending on December 31, 2014 (each twelve month period is a "Guarantee Period"). With <br /> respect to the aspects of United's performance addressed in this exhibit, these fee adjustments are Customer's <br /> exclusive financial remedies. <br /> These guarantees will become effective upon the later of(1) the effective date of the Guarantee Period; or(2) the <br /> date this Agreement is signed by both parties. In the event these guarantees become effective later than the effective <br /> date of the Guarantee Period: (1) quarterly guarantees will become effective beginning with the next calendar <br /> quarter following signature of this Agreement by both parties and (2) annual guarantees will become effective <br /> commencing with the Agreement Period during which this Agreement is signed by both parties. <br /> United reserves the right from time to time to replace any report or change the format of any report referenced in <br /> these guarantees. In such event,the guarantees will be modified to the degree necessary to carry out the intent of the <br /> parties. United shall not be required to meet any of the guarantees provided for in this Agreement or amendments <br /> thereto to the extent its failure is due to Customer's actions or inactions or if United fails to meet these standards due <br /> to fire, embargo, strike, war, accident, act of God, acts of terrorism or United's required compliance with any law, <br /> regulation,or governmental agency mandate or anything beyond United's reasonable control. <br /> Prior to the end of the Guarantee Period, and provided that this Agreement remains in force, United may specify to <br /> Customer in writing new performance guarantees for the subsequent Guarantee Period. If United specifies new <br /> performance guarantees,United will also provide Customer with a new Exhibit that will replace this Exhibit for that <br /> subsequent Guarantee Period. <br /> Claim is defined as an initial and complete written request for payment of a Plan benefit made by an enrollee, <br /> physician, or other healthcare provider on an accepted format. Unless stated otherwise, the claims are limited to <br /> medical claims processed through the UNET claims systems. Claims processed and products administered through <br /> any other system, including claims for other products such as vision, dental, flexible spending accounts, health <br /> reimbursement accounts, health savings accounts, or pharmacy coverage, are not included in the calculation of the <br /> performance measurements. Also, services provided under capitated arrangements are not processed as a typical <br /> claim;therefore capitated payments are not included in the performance measurements. <br /> A formal implementation plan,which defines key tasks,dependencies and completion dates will be developed and agreed to by <br /> both parties. The lack of a mutually agreeable formal implementation plan will nullify these implementation guarantees in total. <br /> Failure on the customer's part to complete,by the agreed upon dates,the key dependent tasks associated with the implementation <br /> guarantees outlined below will also nullify that guarantee. <br /> Initial ID Card Issuance <br /> ID cards will be postmarked within the parameters set forth after the final eligibility data has been system <br /> Definition loaded,passed a quality assurance check,passed a system load test and has been released to the ID card <br /> production area. <br /> Measurement Percents e of cards issued 1 99°!0 <br /> Issuance time frame,business days or less business days 1 10 <br /> Calculated on a pro-rated basis,based on the actual number of late cards as a percent of the total number of <br /> Criteria cards. ID card turnaround time guarantees are based on United's performance during the implementation <br /> process. <br /> I eveI" Customerspecific <br /> Period" Initial im lementation timeframe <br /> PaymentTeriod Annually <br /> Fees at Risk Total Dollars at Risk for this metric $3,900 <br /> Payment Amount Of the Fees at Risk for this metric,percentage at risk for each gradient N/A <br /> Gradients Not applicable <br /> 23 <br />
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