PG-13 Member call 85% of member calls Quarterly vendor 1% of fees if resolution resolved on first call. report including performance is phone and less than the Time over which customer service standard. standard is measured: system reporting. Quarter PG-14 Provision of Draft Plan Document Receipt date as $500 per day for Plan Documents documented by the first three Provided to the State at vendor and calendar days that least 2 months prior to Evidence of confirmed by State. the draft the first day of the plan Coverage for document is not year. This should be an plans and received. error-free (content and Summary Plan grammar) document. Description for the $1,000 per fully-insured plans calendar day for each day the draft document is not received for the fourth calendar day and beyond. PG-15 Provision of Final Plan Document Receipt date as $500 per day for Plan Documents documented by each calendar day Includes all of the vendor and the draft plan required edits and in Evidence of confirmed by document is not the format ready for Coverage for received for the posting to State plans and first 3 calendar intranet. Returned to Summary Plan days. the State within 10 Description for the calendar days of the $1,000 per day for fully-insured plans carrier’s receipt of the each day the State’s edits. plan document is not received for the fourth calendar day and beyond. PG-16 Claims 99% of claim dollars Measures the gross 2.00% of fees if Accuracy processed accurately. dollars paid between 97% - Measured by the incorrectly 98.99%, 4.00% of independent auditor as (overpayments plus fees if less than part of the annual underpayments) 97%. Choose an claims audit. Measured subtracted from item. to two (2) decimal total paid claim places. dollars, divided by total paid claim dollars within the audit sample.
PG-13 Member call resolution 85% of member calls resolved on first call. Time over which standard is measured: Quarter Quarterly vendor report including phone and customer service system reporting. 1% of fees if performance is less than the standard. PG-14 Provision of Plan Documents Evidence of Coverage for plans and Summary Plan Description for the fully-insured plans Draft Plan Document Provided to the State at least 2 months prior to the first day of the plan year. This should be an error-free (content and grammar) document. Receipt date as documented by vendor and confirmed by State. $500 per day for the first three calendar days that the draft document is not received. $1,000 per calendar day for each day the draft document is not received for the fourth calendar day and beyond. PG-15 Provision of Final Plan Documents Evidence of Coverage for plans and Summary Plan Description for the fully-insured plans Plan Document Includes all of the required edits and in the format ready for posting to State intranet. Returned to the State within 10 calendar days of the carrier’s receipt of the State’s edits. Receipt date as documented by vendor and confirmed by $500 per day for each calendar day the draft plan document is not received for the first 3 calendar days. $1,000 per day for each day the plan document is not received for the fourth calendar day and beyond. PG-16 Claims Accuracy 99% of claim dollars processed accurately. Measured by the independent auditor as part of the annual claims audit. Measured to two (2) decimal places. Measures the gross dollars paid incorrectly (overpayments plus underpayments) subtracted from total paid claim dollars, divided by total paid claim dollars within the audit sample. 2.00% of fees if between 97% - 98.99%, 4.00% of fees if less than 97%. Choose an item.
DentalPlanAttachmentT-DPPO-SFform.docx