Schedule H Service Level Agreements.xlsx
XLSX spreadsheet 16 KB Posted
- Attached to
- MPSERS Dental Benefit Plan Administration
- Solicitation number
- RFP-171-200000001290-3
- Issued by
- Grand Traverse County, Lansing City, Michigan
About this file
This is a Service Level Agreement (SLA) Schedule document for the State of Michigan RFP No. 200000001290. The document outlines 17 distinct SLAs covering various performance requirements including eligibility uploads, membership card distribution, contractor performance evaluation, member satisfaction surveys, customer service metrics, reporting requirements, claims processing, and implementation standards. Each SLA includes specific performance metrics that must be measured and reported either monthly, quarterly, or annually, with corresponding financial penalties for non-compliance.
The financial penalties range from $4,000 to $25,000 per occurrence depending on the severity and nature of the performance failure. Key performance metrics include 100% accuracy for eligibility uploads within one business day, membership card distribution within 10 days, customer service answer times of 120 seconds or less, 95% of clean claims processed within 10 business days, and financial accuracy rates of 99% or higher. The contractor must provide detailed process documentation and approved reports to verify compliance with each SLA, with the State reserving the right to independently verify performance through state employees or third-party review.
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Text version
Sheet1
STATE OF MICHIGAN
| RFP No. 200000001290 |
| SCHEDULE H |
| SERVICE LEVEL AGREEMENTS |
| 1. The Contractor must ensure that the SLAs are measurable using the Contractor’s standard management information systems. SLAs must be measured using data attributable only to the Plan Sponsor’s membership. The Contractor must provide process documentation detailing out the Contractor’s internal processes used to gather and measure the data needed to verify the Contractor’s performance. This process documentation must be provided to the Plan Sponsor no later than the end of the first quarter of the contract period and anytime thereafter when a significant change is made to the process. |
| 2. Every SLA must have a report provided that has been approved by the Plan Sponsor to verify the SLA has been met. SLAs without a corresponding report will be deemed unmet and subject to the penalty. The Plan Sponsor reserves the right to independently verify the Contractor’s assessment of its performance, either by State employee or third-party review. Disagreements regarding SLAs will be subject to Dispute Resolution (See Standard Contract Terms, Section 55). |
| 3. The SLAs are related to ongoing Services and will apply throughout the duration of the Contract, including any optional renewal periods (if exercised). SLAs are for all Services provided under this Contract for the Plan Sponsor. Penalties will be assessed for the month in which performance was assessed. No individual SLA shall be assessed more than one penalty for the month, quarter, or year in which performance was assessed. |
| 4. Plan Sponsor has the right to reallocate the total amount at risk among the various individual guarantees annually. Reallocation cannot increase the annual value of any one component by more than 10% of the original value. Reallocation will not increase the overall aggregate value of the penalties. Any such reallocation must be received by Contractor at least 10 business days prior to the applicable calendar year, otherwise attempted reallocations will be of no effect. |
| Service Levels |
| SLA #1 |
| Eligibility Uploads |
| Guarantee |
| 100% of all accurate records that pass the Contractor's validation edits must be uploaded according to the Plan Sponsor's schedule within one Business Day of receipt. The SLA report must show weekly activity defined as the number of records uploaded within the above timeframe. |
Any records that do not pass the Contractor's validation test must be reported to the Plan Sponsor within two Business Days after the file has been uploaded in the format specified by the Plan Sponsor. The SLA report must show weekly activity defined as the number of records not accepted and the timeframe for presenting the discrepancy reports to the Plan Sponsor.
The Contractor must measure its performance on this SLA on a monthly basis and report on a quarterly basis.
| Penalty |
| The penalty for failure to meet this SLA is $4,000 for each month that the SLA is not met. |
| SLA #2 |
| Membership Cards - Timeliness and Accuracy |
| Guarantee |
| Membership cards for all new Contract Holders must be mailed within 10 days of Contractor loading eligibility record. Performance must be substantiated by documentation providing proof of receipt date and mailing date . |
Accuracy must be measured by sampling ID card production to ensure 100.00% accuracy of information.
The Contractor must measure monthly and report its performance on this SLA on a quarterly basis.
| Penalty |
| The penalty for failure to meet the Identification Card Timeliness SLA is $4,000.00 for each month that the SLA is not met. |
The penalty for failure to meet the Identification Card Accuracy SLA is $4,000.00 for each month that the SLA is not met.
| SLA #3 |
| Contractor Performance Evaluation |
| Guarantee |
| The Plan Sponsor's satisfaction with Contractor performance must be rated an average of 4.00 or above on a scale of 1 to 5. The Contractor will be measured using the Plan Sponsor's annual survey to assess the Contractor's performance within the following categories: |
Senior Account Manager Performance Member Communications Data Reporting Customer Service Administrative Support
The Contractor's total performance score will be determined by weighting equally the overall satisfaction scores of each of the five categories. An overall score under 3.50 will result in an additional penalty.
| Penalty |
| The penalty for failure to meet this SLA is $8,500.00 for an overall score less than 4.00. Failure to score at least 3.50 will result in an additional penalty of $4,000.00. |
| SLA #4 |
| Member Satisfaction Surveys |
| Guarantee |
| One random sample Member satisfaction survey must be competed annually at no additional cost. |
The survey must be completed within each Plan Year for the Plan Year. The survey instrument must be presented to the Plan Sponsor for approval of questions and scoring methodology prior to deployment. Plan Sponsor has the authority to request changes and customization to the survey and scoring methodology. The respondent pool must be statistically valid based on the Plan Sponsor's total population (randomly generated sample size sufficient to produce a 95% confidence interval with a margin of error not greater than +/- 3%). Survey results must be available to the Plan Sponsor by Q3 within the Plan Year unless a different date is agreed upon.
Contractor must achieve a score of 4.00 or higher on a 5.00 scale (other scoring scales may be used as long as they are equivalent) from 85.00% of the responders.
| Penalty |
| The penalty for failure to meet this SLA is $8,500.00. Failure to achieve a score of 4.00 or higher from at least 80.00% of responders will result in an additional penalty of $4,000.00. |
Failure to conduct the survey as required in the Guarantee will result in a $12,500.00 penalty.
| SLA #5 |
| Customer Service Call - Average Speed of Answer |
| Guarantee |
| The Contractor shall maintain an average speed of answer of 120 seconds or less. The ASA standard will be applied to the speed at which the initial call is answered by a CSR. Should the caller need to be transferred to another level CSR, the time associated with that transfer shall not be included in the ASA calculation. |
The Contractor must measure monthly and report their performance on this SLA on a quarterly basis.
| Penalty |
| The penalty for failure to meet this SLA is $4,000.00 for each month the SLA is not met. |
| SLA #6 |
| Customer Service Call - Telephone Servicing Factor |
| Guarantee |
| 80.00% of calls must be left in queue (IVR) for service less than 30 seconds. |
The Contractor must measure its performance on this SLA on a monthly basis and report on a quarterly basis.
| Penalty |
| The penalty for failure to meet this SLA is $4,000.00 for each month the SLA is not met. |
| SLA #7 |
| Customer Service Response Time - Percent of Calls Abandoned |
| Guarantee |
| The monthly call abandonment rate must not exceed 5.00%. |
The Contractor must measure its performance on this SLA on a monthly basis and report on a quarterly basis.
| Penalty |
| The penalty for failure to meet this SLA is $4,000.00 for each month the SLA is not met. |
| SLA #8 |
| Customer Service Response Time - Written Inquiries |
| Guarantee |
| The Contractor must respond to 95.00% or more of Written inquiries within 14 Days of receipt, 98.00% of all Member inquiries must be responded to within 28 Days, and 99.50% of Written inquiries must be responded to within 60 Days. Written inquiries will include those forwarded to the Contractor by the Plan Sponsor. |
Contractor must measure monthly and report their performance on this SLA on a quarterly basis.
| Penalty |
| The penalty for failure to meet this SLA is $4,000.00 for each month the SLA is not met. |
| SLA #9 |
| Timely Production of Complete Management Reports |
| Guarantee |
| The Contractor must provide complete quarterly reports within 45 Days of the end of the quarter, and annual reports within 90 days of Plan year end. |
The Contractor must measure and report its performance on this SLA on a quarterly or annual basis respectively.
| Penalty |
| For quarterly reports, the penalty for failure to meet the reporting requirements of this SLA is $4,000.00 for each quarter the SLA is not met. |
For annual reports, the penalty for failure to meet the reporting requirements of this SLA is $4,000.00 per year that the SLA is not met.
| SLA #10 |
| Appeals Reporting Requirements |
| Guarantee |
| The Contractor must administer the Appeals Policies that are compliant with accreditation agency requirements. |
Reporting will include the response time of Appeal processing (60 Days for post-service).
Reporting for appeals to include the Member count, nature of Appeal, timeliness of handling, and outcome (Member resolution).
The Contractor must measure its performance on this SLA on a quarterly basis and report on an annual basis.
| Penalty |
| The penalty for failure to meet the response time requirements of this SLA is $4,000.00 for each quarter missed the SLA is not met. |
| SLA #11 |
| Timeliness of Data Transmission to the Plan Sponsor's Data Management Vendor |
| Penalty |
| The Contractor must agree to deliver Claim data files to the Plan Sponsor's Data Contractor in an agreed-upon format. Delivery of data files - with all required fields correctly populated - must be completed within 15 Days after the close of each month. If the 15th falls on Saturday or Sunday, the data file can be delivered the following Monday without penalty. |
| Penalty |
| The penalty for failure to meet this SLA is $4,000.00 for each month the SLA is not met. |
| SLA #12 |
| Financial Error Rate |
| Guarantee |
| The financial error rate must be calculated on a monthly basis by using a statistically significant sampling method to produce at least 95% confidence in the results and a +/- 3.00% precision. The resultant error rate (as defined as the number of claims in the sample containing a financial error divided by the total number of claims in the sample) must not exceed 3.00%. |
The Contractor must measure monthly and report its performance on this SLA on a quarterly basis.
| Penalty |
| The penalty for failure to meet this SLA is $8,500.00 for each month the SLA is not met. |
| SLA #13 |
| Non-financial Error Rate |
| Guarantee |
| The non-financial error rate must be calculated on a monthly basis by using a statistically significant sampling method to produce at least 95.00% confidence in the results and +/- 3.00% precision. The resultant error rate (as defined as the number of claims in the sample with a non-financial error divided by the total number claims in the sample) must not exceed 3.00%. |
The Contractor must measure monthly and report its performance on this SLA on a quarterly basis.
| Penalty |
| The penalty for failure to meet this SLA is $4,000.00 for each month the SLA is not met. |
| SLA #14 |
| Claims Processing Time |
| Guarantee |
| 95.00% of all clean claims must be processed within 10 Business Days. |
99.50% of all clean claims must be processed within 15 Business Days.
The Contractor must measure its performance on this SLA on a monthly basis and repot on a quarterly basis.
| Penalty |
| The penalty for failure to meet this SLA is $4,000.00 for each month the SLA is not met. |
| SLA #15 |
| Financial Accuracy Rate |
| Guarantee |
| Financial Accuracy Rate must be calculated on a monthly basis using a statistically significant sampling method to produce at least 95.00% confidence in the results and +/- 3.00% precision. The resultant accuracy rate (as defined as the total dollar value of claims paid, minus the sum of the absolute value of financial errors on claims processed, divided by the total dollar value of claims paid) must not fall below 99.00%. |
The Contractor must measure its performance on this SLA on a monthly basis and report on a quarterly basis.
| Penalty |
| The penalty for failure to meet this SLA is $8,500 for each month that the SLA is not met. |
| SLA #16 |
| Implementation Project Plan, Timeliness, and Accuracy |
| Guarantee |
| Contractor must provide to Plan Sponsor, for review and approval, an initial Project Plan which highlights tasks and interdependencies, critical dates, as well as roles and responsibilities ("Project Plan"). After initial baseline, the Project Plan must be updated as needed with Contractor, providing Project Plan updates, which reflect any changes or updates, to Plan Sponsor for review and approval. Plan Sponsor will select up to five specific tasks listed on the Project Plan, after the establishment of the initial base line Project Plan, to be met on time as documented within the Project Plan and with 100.00% accuracy. |
| Penalty |
| Failure to meet the critical dates outlined in the Project Plan and/or 100% accuracy of each item selected by the Plan Sponsor will result in a $25,000.00 penalty |
| SLA #17 |
| Implementation Project Plan Meeting |
| Guarantee |
| Plan Sponsor may assess a penalty, if, within 45 days after the Effective date, Plan Sponsor's benefit / implementation staff, who are active members of the implementation team, do not rate Contractor's implementation performance an average of 3 or better on a scale of 1 to 5 ( 5 being best). |
| Penalty |
| The penalty for failure to meet this SLA is $25,000.00 per contract period. |
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