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HomeMy WebLinkAboutContractCAG-78-226+IMAEXHIBITASCHEDULEOFFEESForAdministrativeFeesCityofRenton/40345034ContractPeriod:01/01/2019through12/31/2019RatesforthecontractedtimeperiodapplytoservicesadministeredbyHMA.Feesforoutsidevendorsaresubjecttochangeatanytime.HMAfeesandcommissionsmayremainineffectbeyondtheabove-statedtermuntilchangedbymutualwrittenagreementoftheparties.ClaimAdministrativeFeesFeeDescription$22.25PEPMforMedicalPlanAdministrationIncludesPharmacyInterface+Integrated00?MaximurnJQHDHPAdministrationIfalldocumentsaresignedandreturnedbyNovember15t,2018.ThenewPEPMwithdiscount:$22.05$5.50HMANetworkAccess$3.75CareManagementBaseServices$10.00PerClaimMedicarefeeforrepricingofoutofnetworkkidneydialysisclaims.30%ofClaimsNegotiation,HospitalBillAudit,andOutofNetworkClaimRe-pricingServicesasoutlinedinSavingsTPAAgreementSection4andasfurtherdefinedunderSection4(l)(xiii)ofExhibitB27%ofSubrogationServicesasoutlinedinSection4(1)ofExhibitBRecoveredTheplanwillreceive73%ofrecoveredfunds.Oftheremaining22%isretainedbyPHIA,5%isFundsretainedbyHMA.*IntheeventoflitigationtoenforcethePlan’srightofrecovery,Phia’sfeewillincreaseto33.3%andHMAshallnotretainanycompensation.16-18%ofOverpaymentRecoveryasoutlinedinSection4(i)ofExhibitBrecoveredo16%-18%recoveryfeeretainedbyAccent*amountochargedasocontingencyfee30%ofFraud,Waste,andAbuseasoutlinedinSection4(i)ofExhibitBsavingso17.5%ofsavingsretainedbyChangeHealthcareSolutionschargedaso12.5%administrativeallowanceretainedbyHMAcontingencyfee*Note,thecontingencyfeechargedbyAccentvariesbasedontheageoftheunderlyingclaim.InnoinstancewillthetotalfeetothePlanexceed18%oftheamountrecovered.HMATPAExhibitAPage1of4revision:7.9.2018DocuSign Envelope ID: D0B2913F-7EA9-4CEC-A722-EB7FDCDC422B -HMAExternalVendorAdministrativeServicesIFeeDescription$4.05EnvisionRxadministrativefee($4.05toEnvisionRX,$0toHMA)AdditionalServicesAcceptDeclineServiceDescription&CostS1.50PEPMforHMANationalDentalNetworkAccess($1.50PEPMinadditiontotheDentalPlanAdministration.)$3.25PEPMforDentalPlanAdministration$0.65PEPMVisionHardwareAdministration$1.35PEPMCOBRAServicesMedical/RxVisionDentalFlexibleSpendingAccount(FSA)administration$3.95PerAccountPerMonth(PAPM)Visacard:Upto2FREEandadditionalorreplacementcardsat$10percard($250perplanfor1-500accounts,$500perplanfor501-3000accounts.Initialset-upfeeandAnnualfeeareinvoicedthroughtheHealthEquityEmployerPortal.)***FSAandHRAarepurchasedoniy,Ifeeappliesat$3.95PAPMHealthReimbursementAccount(HRA)administration$3.95PerAccountPerMonth(PAPM)Visacard:Upto2FREEandadditionalorreplacementcardsat$10percard($250perplanfor1-500accounts,$500perplanfor501-3000accountsannualfee.Initialset-upfeeandAnnualfeeareinvoicedthroughtheHealthEquityEmployerPortal.)***FSA_and_HRA_are_purchased_only,_1_fee_applies_at_$3.95_PAPMHealthSavingAccount(HSA)administration$2.70PerAccountPerMonth(PAPM)HMATPAExhibitAPage2of4revision:7.9.2018DocuSign Envelope ID: D0B2913F-7EA9-4CEC-A722-EB7FDCDC422B +IMAAcceptDeclineServiceDescription&CostVisacard:Upto3FREEandadditionalorreplacementcardsat$5percard(Noset-upfees)LimitedPurposeFSA(LPFSA)administration$1.95PerAccountPerMonth(PAPM)ElVisacard:Upto3FREEandadditionalorreplacementcardsat$5percard(Noset-upfees)***LimitedPurposeFSA(LPFSA)canbeaddedonlywithHSAoffering.El$2.00PEPMThePlanAppointedClaimEvaluator“PACE”FiduciaryService$1.50PEPM-HealthcareBluebookplusthecostoftheGoGreentoGetGreenRewardsElProgram.Rewardsare$25-$100perservice.MDLiveTelehealth:MedicalEl$l.00PEPM+$38/visitBehavioralHealthEl$30PEPM+PervisitconsultingfeeEl$1.50PEPM-CareNavigator$6.50PEPM-DiseaseManagement&WeilnessHub&WeilnessCoaching(BundledService)ElIfaclientselectsallthreeservicestheywillreceiveadiscountonthebundledservice,$1.00discountifsoldtogether.$1.50PEPM-WellnessHub-includesapersonalhealthassessment,individualandcompanyElchallenges,fitnessdeviceandappintegration,healthdecisionsupporttools,andacustomizablevellnessincentivetracker.$2.50PEPM-WelinessCoaching-Includesunlimitedinboundhealthcoachingviaphone,Elemailorvideoconferencingforworkingonweilnessgoalssuchasstressmanagement,tobaccocessation,eatinghealthierandbeingmorephysicallyactive.Incentiveadministration-InadditiontotheWelinessHubfullincentiveadministrationsupportforoutcomes-basedincentivesisavailable.ThisincludescompleteadministrationofElcustomizedincentivecampaign,includingdesign,creation,management,trackingandreportingisavailablefor$100/hr.$3.50PEPM-DiseaseManagement—IncludesnursecoachingandoutreachforsixmajorElchronicconditions—diabetes,asthma,coronaryarterydisease(CAD),congestiveheartfailure(CUF),chronicobstructivepulmonarydisease(COPD)anddepression.El$350.00PerCase-MaternityProgramEl$0.65PEPM-24HourNurseLineElBiometricScreening-$60.00PerParticipant(25minimumparticipation)ElCoordinationofSPDprintingservices-cost+20%ElIDrecardfee$2.00peremployee(Incidentalreissuenocost)ElElOther:HMATPAExhibitAPage3of4revision:7.9.2018DocuSign Envelope ID: D0B2913F-7EA9-4CEC-A722-EB7FDCDC422B +IMAExcessLossServicesIncompensationfortheworkthatHMAdoestosupportexcesslosscarriers,HMAreceivesanadministrativeallowanceof2.5%frommostofourpreferredcarriers.Ifyouareusinganon-preferredcarrier,therewillbeaninterfacefeeof3.0%ofexcesslosspremittmthatisassessedtothegroupinlieuoftheadministrativeallowance.TheseexcesslossfeeswillbereflectedontheinvoiceonaPEPMbasis.HMAreservestherighttodeclinetoworkwithnon-preferredexcesslosscarriers.Ifweagreetoadministeraplanwithanexcesslosscarrierthatisnotpreferred,wewillchargeaninterfacefeeof3.0%ofexcesslosspremiumandwillaskforasignedwaiverofliabilityfromthegroup.Forcarrierswherewearenotanapprovedbenefitadministrator,FilvIAreservestherighttodeclinetoproceedwiththeapprovalprocessatourdiscretion.Fornewgroups,theinterfacefeefornon-preferredcarriersisbasedonthecarriersprojectedenrollmentandpremiumrates.Forrenewinggroups,theinterfacefeefornon-preferredcarriersiscalculatedbasedonthefinalstoplossrenewalpremiumratesandenrollmentforthelastmonthofthepriorcontractperiod.Theratesarecalculatedasfollows:[.03x(singleSpecificStopLossPremiumRatexsingleenrollment)+(familySpecificStopLossPremiumRatexfamilyenrollment)+(AggregateStopLossPremiumRatextotalenrollment)]/TotalEnrollmentAcceptanceINWITNESSWHEREOF,thepartieshavecausedthisAgreementtobeexecutedbytheirdulyauthorizedrepresentativesontherespectivedatessetforthbelow,effectiveasofthedayandyearfirstabovewritten.HMATPAExhibitArevision:7.9.2018DocuSign Envelope ID: D0B2913F-7EA9-4CEC-A722-EB7FDCDC422BOctober 24, 2018 | 3:39 PM PDT