Schedule I - SLA Reporting Format Final.pdf

Penalty OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEPT

Monthly Monthly Reports within 45 days of month end.

Quarterly Quarterly Reports within 45 days of quarter end.

Annual Annual reports due within 90 days from the fiscal year end.

Actual

Penalty $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Actual

Penalty $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Actual

Penalty $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Actual

Penalty $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Actual

Penalty $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

SLA #2: 95.00% or greater of Member calls to Contractor’s toll-free telephone line must be resolved within 24 hours of a Customer Service Representative’s receipt of the call. A call is considered unresolved if a Member calls Contractor’s toll-free telephone line with the same ‘reason for call’ within the immediately subsequent five day period. Members following up on same issue within seven calendar days cannot be considered resolved. Contractor must measure monthly and report their performance on this SLA on a quarterly basis.

The penalty for failure to meet this SLA is 1.50% of Contractor’s total Administration fee for the month missed.

1.5% 95.0%

SLA #3: On a monthly basis, 95.00% of the calls must be answered in 30 seconds or less. Contractor must measure monthly and report their performance on this SLA on a quarterly basis. The penalty for failure to meet this SLA is 1.50% of Contractor’s total Administration fee for the month missed.

1.5% 95.0%

FY 2018-2019 Standard

First Call Resolution

Identification Cards

SLA #1a: 100% of new Contract Holders’ ID Cards must be mailed within 10 days of Contractor receiving eligibility record. The Contractor must measure monthly and report its performance on this SLA on a quarterly basis. Performance must be substantiated by documentation providing proof of receipt date and mailing date.The penalty for failure to meet the Identification Card Timeliness SLA is 1.00% of the monthly Administration Fee for each month missed.

1.0% 100.0%

SLA #1b: ID Cards must have an accuracy rate of 99.00% or higher. The Contractor must measure monthly and report its performance on this SLA on a quarterly basis.

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 99.00% accuracy of information. The penalty for failure to meet the Identification Card Accuracy SLA is 1.00% of the monthly Administration Fee for each month missed.

1.0% 99.0%

SLA #4: The monthly call abandonment rate must not exceed 3.00% (determined by the number of calls abandoned by the total number of calls). A call will be considered abandoned if the Member hangs up at any time after initiating a transfer out of the IVR. Contractor must measure monthly and report their performance on this SLA on a quarterly basis. The penalty for failure to meet this SLA is 2.00% of Contractor’s monthly Administration fee for each month missed.

2.0% 3.0%

Customer Service

Contract Value: Q3:

Contract Options Remaining: Q4:

VISION CONTRACT

BENEFIT CONTRACT PERIOD: October 1, 2019 - September 30, 2022 Quarterly Compliance Review Date:

Account Representative: Q1:

Contract Designee: Becky Guyski Q2:

Contract Number: Annual review:

RFP No. 180000001030

Penalty OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEPTFY 2018-2019 Standard

Contract Value: Q3:

Contract Options Remaining: Q4:

VISION CONTRACT

BENEFIT CONTRACT PERIOD: October 1, 2019 - September 30, 2022 Quarterly Compliance Review Date:

Account Representative: Q1:

Contract Designee: Becky Guyski Q2:

Contract Number: Annual review:

95.0% Actual

Actual

Penalty $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

2.0% 85.0% Actual

3.0% 80.0% Penalty

TRUE Actual Monthly

Actual Quarterly

Penalty

Actual Annual

Penalty

Actual

Penalty $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Actual

Penalty $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

SLA #7b: Each monthly report must be received timely within the respected timeframe of the report in order to meet the quarterly SLA. The penalty for failure to meet the annual report dealine will be 2.00% of the yearly averaged quarterly Administrative Fee paid to the Contractor by the Plan Sponsor.

2.0% TRUE

$0.00

Reporting

2.0%

TRUE

$0.00

1.0% 99.0%

Error Rates

SLA #8: The financial error (as defined as the number of claims containing a financial error divided by the total number of claims) must not exceed 1.00%. Contractor must measure monthly and report its performance on this SLA on a quarterly basis. The penalty for failure to meet this SLA is 5.00% for each month missed of Contractor’s monthly Administration Fee.

5.0% 99.0%

SLA #9: The non-financial error rate (as defined as the number of claims with a non-financial error divided by the total number of claims) must not exceed 1.00%. Contractor must measure monthly and report its performance on this SLA on a quarterly basis. The penalty for failure to meet this SLA is 1.00% for each month missed of Contractor’s monthly Administration Fee.

$0.00

SLA #5: Contractor must resolve 95.00% of all Member Inquiries within five Business Days of receipt; 100.00% of all Inquiries must be resolved within 10 Business Days.

Inquiries will include those forwarded to the Contractor by the Plan Sponsor and the receipt date will be considered the date the inquiry is received by the Contractor. Contractor must measure monthly and report their performance on this SLA on a quarterly basis. The penalty for failure to meet this SLA is 1.00% of Contractor’s administrative fee for each month missed.

1.0%

100.0%

SLA #7a: Contractor must provide complete monthly and quarterly reports within 45 Days of the end of the month and quarter, and annual reports within 90 days of Plan year end, as outlined in the contract (Section 4.3 Reporting). The Contractor must measure and report its performance on this SLA on a quarterly or annual basis, depending on report.

The penalty for failure to meet the reporting requirements of this SLA is 2.00% per quarter not met, of the total quarterly Administrative Fee paid to the Contractor by the Plan Sponsor for each quarter that the SLA is not met.

$0.00 $0.00 $0.00

Member Satisfaction

Surveys

SLA #6: One statistically valid randomly sampled Member survey must be completed annually within the Contract year being assessed. Survey tool, methodology, and scoring criteria must be mutually agreed upon within the first three months of Contract effective date. Results must be delivered to the Plan Sponsor within 90 days. The penalty for failure to meet 85.00% survey satisfaction is 2.00% of Contractor’s annual Administration Fee. Failure to reach 80.00% will result in an additional 1.00% penalty of Contractor’s annual Administration Fee.

Inquiry Handling

Penalty OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEPTFY 2018-2019 Standard

Contract Value: Q3:

Contract Options Remaining: Q4:

VISION CONTRACT

BENEFIT CONTRACT PERIOD: October 1, 2019 - September 30, 2022 Quarterly Compliance Review Date:

Account Representative: Q1:

Contract Designee: Becky Guyski Q2:

Contract Number: Annual review:

Actual

Penalty $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Actual

Penalty $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Actual

Penalty $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Admin Fees Per Contract Per Month $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

# of Contracts Monthly total of contracts (Active, Retiree, & COBRA) 0

Audit Timing Status: Completed (mm/dd/yy) for 10/01/19 - (mm/dd/yy)

Penalty Penalty due within 45 days of the quarter end.

Appeal Process Yes

HIPAA BAA Signed (mm/dd/yy)

Change Notices

Indicates that COBRA is not added yet in the enrollment count.

Amount Paid (Q1 ): Amount of Penalty Paid (Q2 ): Amount of Penalty Paid (Q3): Amount of Penalty Paid (Q4):

3.0%

Total Penalty Due (Q1): Total Penalty Due (Q2): Total Penalty Due (Q3): Total Penalty Due (Q4):

Date Penalty Fees Paid (Q1): Date Penalty Fees Paid (Q2): Date Penalty Fees Paid (Q3): Date Penalty Fees Paid (Q4):

Claims Turn Around

SLA #10: The average time between when Claims have been received and paid must not exceed 10 Days.

Contractor must measure monthly and report its performance on this SLA on a quarterly basis. The penalty for failure to meet this SLA is 1.5% for each month missed of Contractor’s monthly Administration Fee.

1.5% 10

SLA #11a: Eligibility Files must be processed accurately and updated within 1 business day of receiving them from the State. Contractor must measure monthly and report its performance on this SLA on a quarterly basis. The penalty for failure to meet this SLA is 3% for each month missed of Contractor’s Administration Fee for the month.

Eligibility Files SLA #11b: Discrepancies must be reported in the format designated by the Plan Sponsor within two business days after file has been uploaded. Contractor must measure monthly and report its performance on this SLA on a quarterly basis. The penalty for failure to meet this SLA is 2% for each month missed of Contractor’s Administration Fee for the month.

2.0% 1

Vision FY19