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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UnitedHealthcare Choice Network Savings Guarantee The Network Savings Guarantee is effective during the incurred period 1/1/2017 through 12/31/2017 and applies only to in- network claims paid within 3 months following the end of the Network Savings Guarantee Period. Commitment r l Less Than 53.1% 30.0% 53.1 % - 54.1% 24.0% 54.1 % - 55.1 % 18.0% 55.1 % - 56.1% 12.0% 56.1 % - 57.1% 6.0% Greater Than 57.1% 0.0% We agree to reimburse CITY OF SAN MARCOS the applicable percentage of the standard medical fees (excluding optional and non - standard fees) at risk noted in the table above based on the shortfall in network discounts achieved and the defined range the result falls into up to a maximum of 30.0% of the standard medical fees (excluding optional and non - standard fees). The UnitedHealthcare Choice product and savings as presented in this document are available under the following assumptions and conditions *: Employees enrolled in a UnitedHealthcare Choice Network Target Network Savings Percentage (Illustrative) Risk Free Corridor 578 59.1% 2.0% For the UnitedHealthcare Choice network to be accessed, a sufficient benefit differential between in and out of network benefits must exist to promote in- network usage. Whether a sufficient benefit differential exists will be measured by UnitedHealthcare with the measurement based on coinsurance differentials, deductible differentials, out of pocket maximum differentials, and combinations of the former, among others. Savings are defined as the sum of: (1) the difference between the covered billed charges (excluding ineligible and not covered charges) submitted by the network provider and the amount based on the negotiated rate with that provider. This may also include specially negotiated discounts with network providers in outlier claim situations. No reasonable and customary (R &C) reductions are taken when a negotiated rate is in place with a network provider. The calculation is performed before the application of copayments, deductibles, or other coinsurance. (2) savings that result from the application of claims payment logic that bundles claims, consistent with provisions in our provider contracts. We reserve the right to exclude claims billed utilizing billing software, showing billed charges (excluding ineligible and not covered charges) equal to the negotiated rate from this guarantee. Claims where UnitedHealthcare is the secondary payor are excluded from the Network Savings and Network Savings Factor determination. Mental Health/Substance Abuse claims are excluded. 34