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Res 2016-077/approving an administrative services agreement with United Healthcare Services, Inc. for the provision of medical, pharmacy, dental, flexible spending accounts (fsa), retiree, online enrollment tool and cobra benefits administration in a tot
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Res 2016-077/approving an administrative services agreement with United Healthcare Services, Inc. for the provision of medical, pharmacy, dental, flexible spending accounts (fsa), retiree, online enrollment tool and cobra benefits administration in a tot
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City Clerk - Document
Resolutions
City Clerk - Type
Approving
Number
2016-77
Date
6/21/2016
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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 referred <br />to as "Fees in this Exhibit ") payable by Customer under this Agreement will be adjusted through a credit to its fees in <br />accordance with the performance guarantees set forth below unless otherwise defined in the guarantee. Unless <br />otherwise specified, these guarantees apply to medical benefits and are effective for the period beginning January 1, <br />2017 and ending on December 31, 2017 (each twelve (12) month period is a "Guarantee Period "). Guarantees will be <br />provided annually thereafter, upon renewal. With respect to the aspects of United's performance addressed in this <br />exhibit, these fee adjustments are Customer's exclusive financial remedies. <br />United reserves the right from time to time to replace any report or change the format of any report referenced in these <br />guarantees. In such event, the guarantees will be modified to the degree necessary to carry out the intent of the parties. <br />United shall not be required to meet any of the guarantees provided for in this Agreement or amendments thereto to <br />the extent its failure is due to Customer's actions or inactions or if United fails to meet these standards due to fire, <br />embargo, strike, war, accident, act of God, acts of terrorism or United's required compliance with any law, regulation, <br />or governmental agency mandate or anything beyond United's reasonable control. <br />Prior to the end of each 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 Percentage of cards issued 99% <br />Issuance time frame, business days or less business days 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 />Level Customerspecific <br />Period Initial implementation timeframe <br />Fees at Risk Total Dollars at Risk for this metric $5,700 <br />Payment Amount Of the Fees at Risk for this metric, percentage at risk for each gradient N/A <br />Gradients Not applicable <br />Claim Ready Date <br />Ready to pay electronic claims by the later of the effective date or within the designated number of days <br />following the completion of key implementation tasks: (i) Account structure and benefit plan details are <br />Definition defined and written approval has been provided by the customer; (ii) final eligibility has been received and <br />successfully tested by United; and (iii) if so negotiated, deductibles and lifetime maximums from the <br />previous carrier received in a mutually agreed upon format, accurate, and loaded electronically. <br />30 <br />
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