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2010-06-07_(2).pdf - 19318.8K - BridgeportCT.gov

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CIGNA HealthCare Performance Guarantee Agreement<br />

Customer Bridgeport City<br />

BOE<br />

Effective Date July 1 <strong>2010</strong><br />

Account Number s involved in Performance Guarantee s 3213172<br />

R@<br />

CIGNA<br />

EXHIBIT B3<br />

DISCOUNT<br />

Table 1<br />

Networks<br />

Service Area Tarlet Network ID Number Service Area Discount<br />

AL HUNT<br />

AL353 28 6<br />

AL SALA AL354 43 6<br />

AZ PHOENIX RURAL<br />

AZ PHOENIX IPA<br />

CA SACRAMENTO<br />

CA CENTRAL VALLEY<br />

CT HARTFORD<br />

AZ300A 38 5<br />

AZ300B 60 0<br />

CA350B 47 3<br />

CA350H 49 9<br />

CT300A 49 3<br />

CT SOUTHERN CONNECTICUT CT300B 49 3<br />

CT WINDHAM CT300C 49 3<br />

FL ORLANDO PROPER FL305A 62 0<br />

FL<br />

LAKE VOLUSIA FL305B 584<br />

FL OCALA GAINESVILLE FL305C 53 3<br />

FL JACKSONVILLE FL305D 53 0<br />

FL COCOA BEACH<br />

FL305E 56 8<br />

FL FORT MYERS FL305F 54 3<br />

FL TAMPA BAY EXPANSION FL305G 59 3<br />

FL TAMPA IPA FL305H 59 0<br />

FL BROWARD COUNTY FU05I 65 8<br />

FL PALM BEACH COUNTY FL305K 67 7<br />

FL MARTIN COUNTY FL305L 63 1<br />

FL PENSACOLA FL305N 49 1<br />

FL SARASOTA FU05S 55 8t<br />

FL VOLUSIA FL305V 562<br />

GA ATLANTA GA300A 60 6<br />

GA NE GEORGIA GA300B 56 3<br />

GA AUGUSTA AIKEN GA300D 552<br />

GA SAVANNAH OUTER GA300H 55<br />

HI HAWAll MDX HI350 419<br />

ID IDAHO PHYSICIAN NETWORK ID352 22 0<br />

MA WESTERN<br />

MA3001 46 0<br />

MA SOUTHEAST MA3005 43 1<br />

VA FAIRFAX<br />

MD300B 52 1<br />

MD OTHER MD MD300C 42 7<br />

VA OTHER VIRGINIA MD300E 46 8<br />

OH TOLEDO MI350C 504<br />

MI DETROIT METRO HAP MI356A 43 7<br />

MO ST LOUIS M0300 58 1<br />

NC TRIANGLE NC300A 50 7<br />

NC CHARLOTTE NC300B 46 9<br />

NC TRIAD NC300C 40 9<br />

OS 28 20 0<br />

<strong>2010</strong> Perfonnance Guarantee Page 17

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