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

CIGNA HealthCare Performance Guarantee Agreement
Customer Bridgeport City BOE
Effective Date July 1 2010
Account Numbers involved in Performance Guarantee s 32131 72
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CIGNA
2 7 Claims for persons over age 65
2 3 In the event any federal state or local
legislation or regulation a impacts
Connecticut General s ability to enter
into Participating Provider Agreements in
one or more Service Areas or b affects
the Eligible Charges in one or more
Service Areas Connecticut General
reserves theright to revise the Service
Area Discount Targets to account for
such changes
24 In the event that Covered Charges remain
flat or decrease in any Service Area
during the Guarantee Period Connecticut
General may adjust the Service Area
Discount Target for that Service Area
accordingly
2 5 In the event there is a substantial change
i e including but not limited to the
addition ofanew participating hospital
termination ofaparticipating hospital in
CIGNA s network in the Service Area
that affects the fmancial discounts
expected in place Connecticut General
may revise the Performance Guarantees
to account for such changes
3 Methodololv
3 1 Discount Target Prior to the Guarantee
Period Connecticut General will identify
the Service Area Discount Target s to be
achieved during the Guarantee Period in
each Service Area
These Service Area
Discount Targets are identified in Table
1 After the end ofthe Guarantee Period
Connecticut General shaIl calculate the
weighted average ofall Service Area
Discount Targets for the Guarantee
Period In calculating the weighted
average ofall Service Area Discount
Targets the proportional relevance
assigned to each Service Area Discount
Target will be determined by dividing the
total ofall Covered Charges for that
Service Area during the Guarantee Period
by the total Covered Charges for all
Service Areas within the same period
32 Actual Discount Within five months
after the end ofthe Guarantee Period
Connecticut General shall determine the
Service Area Disc ount s actually
achieved during the Guarantee Period in
each Service Areal
Connecticut General
shaIl then calculate the weighted average
ofall the Service Area Discounts during
the Guarantee Period In calculating the
weighted average ofthe Service Area
Discounts the proportional relevance
assigned to each Service Area Discount
will be determined by dividing the total
Covered Charges for that Service Area
during the Guarantee Period by the total
Covered Charges for all Service Areas
during the same pi riod
4 Risk Sharin Guslrantees
4 1 Ifthe Actual Discount is within 2 that
is that number of percentage points plus
or minus ofthe Discount Target the
Risk Free Corridor
no amounts will
be owed by Connecticut General under
this Agreement
4 2 Ifthe Actual Discount is less than the
Discount Target and not within the Risk
Free Corridor Cotmecticut General will
payor credit to Employer
42 1 4 00 Per Employee Per Month if the
Actual Discount is within 21 to 4
percentage points ofthe Discount
Target or
422 8 00 Per Employee Per Month ifthe
Actual Discount is greater than 4
percentage points ofthe Discount
Target
5 Evaluation of Performance and
Pavment Amounts
5 1 Connecticut General shall provide the
Performance Report to Employer within
five 5 months foIlowing the end ofthe
Guarantee Period
52 Connecticut General or Employer as the
case may be shall payor credit to the
05 28 2010
20 0 Performance Guarantee
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