“Qualified Dental Plan” has the meaning set forth under Insurance Article §31-101(p), Annotated Code of Maryland. “Qualified Employer” has the meaning set forth under Insurance Article §31-101(q), Annotated Code of Maryland. “Qualified Health Plan (QHP)” has the meaning set forth under Insurance Article §31-101(r), Annotated Code of Maryland; and 45 CFR Parts 155 and 156. “Qualified Plan (QP)” has the meaning set forth under Insurance Article §31-101(t), Annotated Code of Maryland. Qualified Plans include Qualified Dental Plans, Qualified Health Plans, and Qualified Vision Plans. Notwithstanding anything to the contrary herein, Qualified Plans shall be considered QPs for purposes of the applicability of federal laws and regulations, including but not limited to 45 CFR Part 156. “Qualified Vision Plan” has the meaning set forth under Insurance Article §31-101(u), Annotated Code of Maryland. “Race, Ethnicity, Language, Interpreter Need, and Cultural Competency” (“RELICC”)” means a subset of the data collected by the Maryland Health Care Commission under Insurance Article §31-119(d)(2)(iii), Annotated Code of Maryland. “SHOP Exchange” has the meaning set forth under Insurance Article §31-101(w), Annotated Code of Maryland. “Third Party Benefit Administrator” or “TPA” means a party engaged by MHBE to provide administrative or other services related to utilizing the MHBE or assisting Carriers in working with Customers.
Accuracy of enrollment change file 95% with 0 errors 2% Billing Accuracy and Timeliness Timeliness of bill presentment / delivery 95% delivered by due date 1% Accuracy of billing 97% with 0 errors 2% Payment Accuracy and Timeliness Timeliness of payment to carriers 97% of bulk payments received transmitted by due date 2% Accuracy of payment to carriers 97% of payments received with 0 errors 2% Performance Standards - Program 2 Service Category Measure Service Level for Full Payment % of Performance Bonus if Service Levels are met or exceeded Customer Service Average speed to answer 30 seconds 1% Percent of calls answered 97% 1% First call resolution 65% 2% Enrollment Timeliness and Accuracy Timeliness of group file submissions 4 business days within the TPAs file generation date 2% Accuracy of group file submissions reviewing premium contribution, premium rates, group demographic information, plan effective date, and group benefits 90% with 0 errors 2% Timeliness of enrollment file submissions 3 business days within TPAs enrollment transaction date. 2% Accuracy of enrollment files 90% with 0 errors 2% Eligibility Change Timeliness and Accuracy Timeliness of special enrollments and change of circumstance processing Within business 2 days of notification of change event by employer 2% Accuracy of enrollment change file 95% with 0 errors 3% Billing Accuracy and Timeliness Timeliness of bill presentment / delivery 95% delivered by due date 2% Accuracy of billing 97% with 0 errors 2% Payment Accuracy and Timeliness Timeliness of payment to carriers 97% of bulk payments received transmitted by due date 2% Accuracy of payment to carriers 97% of payments received with 0 errors 2%
Performance Standards - Program 3 Service Category Measure Service Level for Full Payment % of Performance Bonus if Service Levels are met or exceeded Customer Service Average speed to answer 30 seconds 3% Percent of calls answered 97% 3% First call resolution 65% 3% Enrollment Timeliness and Accuracy Accuracy of group file submissions reviewing premium contribution, premium rates, group demographic information, plan effective date, and group benefits 90% with 0 errors 3% Accuracy of enrollment files 90% with 0 errors 3% Eligibility Change Timeliness and Accuracy Timeliness of special enrollments and change of circumstance processing Within business 2 days of notification of change event by employer 3% Accuracy of enrollment change file 95% with 0 errors 3% Billing Accuracy and Timeliness Timeliness of bill presentment / delivery 95% delivered by due date 2% Accuracy of billing 97% with 0 errors 2%