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

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CIGNA HealthCare Performance Guarantee Agreement Customer Bridgeport City BOE Effective Date July 1 <strong>2010</strong> Account Number s involved in Performance Guarantee s 3213172 11m CIGNA NC TRIANGLE NON CORE NC CHARLOTTE NON CORE NC300D 49 2 NC300E 45 3 NC WILMINGTON NC300F 474 NC EAST NC NC300G 42 7 NE MIDLANDS CHOICE NE lA SD NE350 28 5 NJ NORTHERN NBOIN 64 3 NV LAS VEGAS NV350A 60 3 NV RENO NV350B 45 7 NY METRO NY300M 55 0 NY WESTERN NY352 26 8 NY MVP MOHAWK VALLEY PHYS NORTHEAST NY NY353N 32 5 OK TULSA OK300B 46 6 PA PHILADELPHIA SUBURBAN P A300A 615 PA SCRANTON WILKES BARRE PA300S 55 PA CENTRAL AREA Z P A300Z 464 RI RHODE ISLAND RI300 37 0 SC COLUMBIA SC300B 47 7 SC PREFERRED SC300E 45 8 SC CHARLESTON SC300H 48 7 SC GREENVILLE SC300l 50 2 TN NASHVILLE INNER TN303B 56 0 TN KNOXVILLE TRI CITIES TN303J 55 3 UT UTAH COUNTY TU300B 454 TX HOUSTON TX302H 59 0 TX EAST HOUSTON TX302Y 59 7 TX SANA TX353 47 5 V A RICHMOND VA300B 59 8 VA LYNCHBURG SOUTH BOSTON VA300F 35 7 VA PENINSULA VA300H 47 1 VA SOUTHSIDE V A300I 44 1 VT STATEWIDE VT VT300A NH SOUTHERN NH VT300K 43 9 37 0 NH COASTAL NH VT300L 412 WV PARKERSBURG WV300 332 OS 28 20I 0 20 I 0 Performance Guarantee Page 18
CIGNA HealthCare Performance Guarantee Agreement Customer Bridgeport City BOE Effective Date July 1 <strong>2010</strong> Account Number s involved in Performance Guarantee s 3213172 II@ CIGNA 1 Additional Definitions 1 1 Actual Discount The weighted average ofall Service AreaDiscounts 1 2 Covered Charges The fee for service charges submitted for reimbursement underthe Plan by Participating Providers for Covered Services calculated as if there were no Discounts 13 Covered Services Health care services and supplies that are covered underthe in network coverage ofthe Plan 14 Discount Target The weighted average ofthe Service Area Discount Targets 1 5 Eligible Charges Covered Charges minus discounts 1 6 Fees at Risk The portion ofnetwork access fees that will be used to calculate the amount that either party may be required to pay the other under this Agreement 1 7 Plan The program ofmedical welfare benefits which Employer has adopted for its Plan Participants and which is administered by Connecticut General The term Plan shall include each change as ofits effective date which has been adopted by Employer and accepted by Connecticut General as compatible with its guarantee obligations hereunder Such adoption and acceptance shall be documented in a writing executed by an authorized officer ofeach ofthe parties 1 8 Service Area Means a location listed in Table 1 where In Network Services are available under the Plan 1 9 Service Area Discount The discount that is calculated by dividing the Eligible Charges by the Covered Charges and subtracting the result from one 1 Example if Covered Charges are 100 and Eligible Charges are 75 then 75 divided by 100 is 75 one minus 75 is 25 or a 25 discount 1 10 Service AreaDiscount Target Means the percentage discount from Covered Charges that Connecticut General expects to achieve through its Participating Provider Agreem nts during the Guarantee Period for all Covered Services in a given Service Area The Service Area Discount Target for each Service Area is identified in Table 1 1 11 Service Termination Date The date on which the Connecticut General Service Agreements andor Policies with respect to the Plan ends not counting any run out periods 2 Additional Conditions Precedent 2 1 The guarantee applies only to Service Areas approved by Connecticut General and identified in Table I 2 This Discount Performance Guarantee agreement and the calculations herein do not apply to 2 1 Charges that are not fee for service charges e g capitation payments 22 Charges for services supplies that are not Covered Services such as COB plan exclusions lJM denials pendedduplicate claims etc 2 2 3 Charges made by providers that are not Participating Providers in a Service Area 2 24 Services provided under an agreement with aprovider where all billed charges equal negotiated discounted charges such as Gentiva NIA etc 2 2 5 Charges made by any CIGNA company e g including but not limited to Tel Drug Inc Tel Drug of Pennsylvania Inc CIGNA Behavioral Health and CIGNA HealthOrre ofArizona staff model Inc s 2 2 6 Claims exceeding 100 000 which will be removed in their entirety and OS 28 20 I 0 20I 0 Perfonnance Guarantee Page 19
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AGENDA CITY COUNCIL MEETING MONDAY
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THE FOllOWING NAMED PERSONS HAVE RE
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And now they are planning on cuttin
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CITY COUNCIL MEETING Monday June 7
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102 09 Communication from Airport M
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73 09 Miscellaneous Matters Committ
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COUNCIL MEMBER BAKER MOVED TO WAIVE
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ADJOURNMENT COUNCIL MEMBER CURWEN M
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DRAFT CHARLES FEREIRA 235 CHURCH ST
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l AWARD BY STIPULATiON FOR FULL AND
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SEVENTEEN THOUSAND FIVE HUNDRED DOL
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IN VIEW OF THE FOREGOING We the und
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BILL FINCH Mayor CITY OF BRIDGEPORT
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B11L of 199r62 fO tl40 1994 02 1082
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1999 04226182 DAY DENEISE G 5 26 20
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2002 02 4924167 BANK LOCK SER vICE
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2003 02 6807922 SANTOS JEWELERS 4 2
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2004 02 6095256 SANTIAGO AUTO SALES
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2004 02 f572541 JAMES R 5AYBAltl AT
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2010-06-07_(2).pdf - 19318.8K - BridgeportCT.gov

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