Financial Consequences apply to each Calendar Day beyond the allowable forty-eight (48) hours, including the date the systems regain availability. Related Contract Reference: Section 6 Network Access Insurer shall provide ninety percent (90%) of Enrollees residing in Insurer’s Service Area with access to one Provider for each of the provider types below within the timeframe and distance listed for rural and urban counties. Provider Type Time (in minutes) Distance (in miles) Rural Urban Rural Urban PCP Pediatrician 30 20 30 20 – PCP Family 20 20 20 20 – Physician OB/GYN 30 30 30 30 Behavioral Health 60 30 45 30 – Pediatric Behavioral Health 60 30 45 30 – Allergy/immunology 60 30 45 30 Dermatology 60 30 45 30 Optometry 60 30 45 30 Otolaryngology 60 30 45 30 (ENT) Specialist Pediatric 40 20 30 20 – Specialist Other 20 20 20 20 – Hospital 30 30 30 20 Pharmacy 15 15 10 10 Financial Consequences: one thousand dollars ($1,000) per percentage point below guarantee per measurement. Calculation Methodology Network access be calculated separately for each provider type and access type (time or distance) and geographical location type (rural or urban). This PG requires fifty-two (52) separate measurements. Financial Consequences shall be assessed for each of the fifty-two (52) measurements, including each access and geographical type and for each Provider type, for which Insurer fails to meet the guarantee.
Financial Consequences apply to each Calendar Day beyond the allowable forty-eight (48) hours, including the date the systems regain availability. Related Contract Reference: Section 6 Network Access Insurer shall provide ninety percent (90%) of Enrollees residing in Insurer’s Service Area with access to one Provider for each of the provider types below within the timeframe and distance listed for rural and urban counties. Provider Type Time (in minutes) Distance (in miles) Rural Urban Rural Urban PCP – Pediatrician 30 20 30 20 PCP – Family Physician 20 20 20 20 OB/GYN 30 30 30 30 Behavioral Health – Pediatric 60 30 45 30 Behavioral Health – 60 30 45 30 Allergy/immunology 60 30 45 30 Dermatology 60 30 45 30 Optometry 60 30 45 30 Otolaryngology (ENT) 60 30 45 30 Specialist – Pediatric 40 20 30 20 Specialist – Other 20 20 20 20 Hospital 30 30 30 20 Pharmacy 15 15 10 10 Financial Consequences: one thousand dollars ($1,000) per percentage point below guarantee per measurement. Calculation Methodology Network access be calculated separately for each provider type and access type (time or distance) and geographical location type (rural or urban). This PG requires fifty-two (52) separate measurements. Financial Consequences shall be assessed for each of the fifty-two (52) measurements, including each access and geographical type and for each Provider type, for which Insurer fails to meet the guarantee.
AttachmentCPerformanceGuarantees.docx