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HomeMy WebLinkAboutHR14-321 - Amendment - #2 - Premera Blue Cross - Administrative Service Contract - Extension - 01/01/2017 en Kecords WASHI„GTON Document aYS 4f PF J $ CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed. If you have questions, please contact City Clerk's Office. Vendor Name d Vendor Number: , LA ID Edwards Number Contract Number: KPU - mi _ c)ol This is assigned by City Clerk's Office Project Name: CA ,m � ..,� , a£ Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment (Contract ❑ Other: Contract Effective Date: i Termination Date: t 4 Contract Renewal Notice (Days): 1 Number of days required notice for termination or renewal or amendment U6,�7�_z- Contract Manager:_ t, z =•-.Department: - ! Contract Amount: r e ,-)E` Approval Authority: (CIRCLE ONE) Department Director Mayor City Council d Detail: (i.e. address, location, parcel number, tax id, etc.): As of: 0e/27/14 r, t PRZEMERA 10 AMENDMENT 2 TO ADMINISTRATIVE SERVICE CONTRACT BETWEEN PREMERA BLUE CROSS AND CITY OF KENT The Administrative Service Contract ("Contract") between the above named group (the "Plan Sponsor") and Premera Blue Cross (the "Claims Administrator") was issued January 1, 2015. The Contract was later updated by the amendment listed below: Amendment 1 from January 1, 2016 to December 31, 2016 This Amendment shall further revise and extend the Contract for the period from January 1, 2017 through December 31, 2017 (the "Contract Period"). The changes to the Contract for the new Contract Period shown below shall take effect on January 1, 2017. The changes are: Section 1 Definitions Some definitions have been added to this section to explain some of the terminology used in the contract: A definition of"allowed amount" has been added: Allowed Amount The Plan provides benefits based on the Allowed Amount for covered services. The Plan Sponsor's liability for covered services is calculated on the basis of the Allowed Amount. The Claims Administrator reserves the right to determine the amount allowed for any given service or supply unless specified otherwise in this Contract. The Allowed Amount is described below. There are different rules for dialysis due to end-stage renal disease and for emergency services. These rules are shown below the general rules. a. General Rules 1. Providers In Washington and Alaska Who Have Agreements With the Claims Administrator For any given service or supply, the amount these providers have agreed to accept as payment in full pursuant to the applicable agreement between the Claims Administrator and the provider. 2. Providers Outside The Service Area Who-Have Agreements With Other Blue Cross Blue Shield Licensees For covered services and supplies received outside the Service Area, Allowed Amounts are determined as stated in "AttachmentA-Out-of-Area Services." 3. Providers Who Don't Have Agreements With the Claims Administrator Or Another Blue Cross Blue Shield Licensee The Allowed Amount for providers in the Service Area that don't have a contract with the Claims Administrator is the least of the three (3) amounts shown below. The Allowed Amount for providers outside the Service Area that don't have a contract with the Claims Administrator or the local Blue Cross and/or Blue Shield Licensee is also the least of the three (3) amounts shown below. • An amount that is no less than the lowest amount the Plan pays for the same or similar service from a comparable provider that has a contracting agreement with the Claims Administrator ASCAM (07-2016) III' An I,dependent Licensee of the Blue Oros Blue Shleld A,t,.mki • 125 percent of the fee schedule determined by the Centers for Medicare and Medicaid Services (Medicare), if available 0 The provider's billed charges. Note: Ambulances are always paid based on billed charges. If applicable law requires a different Allowed Amount than the least of the three (3) amounts above, this Plan will comply with that law. b. Dialysis Due To End Stage Renal Disease a 1. Providers Who Have Agreements With the Claims Administrator Or Other Blue Cross Blue Shield Licensees The Allowed Amount is the amount explained above in this definition. 2. Providers Who Don't Have Agreements With the Claims Administrator Or Another Blue Cross Blue Shield Licensee The amount the Plan allows for dialysis will be no less than 125 percent of the Medicare- approved amount and no more than 90 percent of billed charges. c. Emergency Care Consistent with the requirements of the Affordable Care Act, the Allowed Amount will be the greatest of the following amounts: 1. The median amount that Heritage Network Providers have agreed to accept for the same services 2. The amount Medicare would allow for the same services 3. The amount calculated by the same method the Claims Administrator uses to determine payment to Non-Contracted Providers Note:. Non-Contracted Ambulances are always paid based on billed charges. In addition to any deductible, copays and coinsurance, Members are responsible for charges received from Non-Contracted Providers above the Allowed Amount. A definition of "medically necessary" has been added: Medically Necessary Those covered services and supplies that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are: • In accordance with generally accepted standards of medical practice; • Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient's illness, injury or disease; and Not primarily for the convenience of the patient, physician, or other health care provider, and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury or disease. For these purposes, "generally accepted standards of medical practice" means standards that are based on credible scientific evidence published in peer reviewed medical literature generally recognized by the relevant medical community, physician specialty society recommendations and the views of physicians practicing in relevant clinical areas and any other relevant factors. i A definition of"network provider" has been added: j Network Provider A provider that is in one of the provider networks chosen by the Plan Sponsor for the Plan. A definition of"non-contracted provider" has been added: Non-Contracted Provider A provider that does not have a network provider contract with the Claims Administrator or, for out-of-area providers, with the local Blue Cross and/or Blue Shield Licensee. 2 A definition of"non-network provider" has been added: Non-Network Provider A provider that is not in one of the provider networks chosen by the Plan Sponsor for the Plan. A definition of"service area" has been added: Service Area The states of Washington (except Clark County) and Alaska Section 5- fees Of The Claims Administrator Subsection 5.2.b. is revised to clarify that Premera's decision to accept a late payment does not affect its right to terminate if a payment for a subsequent month is paid late or not at all: b. In the event of late payment, the Claims Administrator may terminate this Contract pursuant to subsection 9.5 below. Acceptance of late payments by the Claims Administrator shall not constitute a waiver of its right to cancel this Contract due to subsequent delinquent or nonpayment of fees. Section 9 Termination We have clarified that Premera's final accounting will be delivered in the sixteenth month after the contract terminates rather than by the end of the fifteenth month. The accounting cannot be done until all processing is complete. The provision now reads: 9.7 Final Accounting Within one hundred twenty (120) days of termination by either party, the Claims Administrator shall deliver to the Plan Sponsor an interim accounting. In the sixteenth month after termination the Claims Administrator shall deliver to the Plan Sponsor a complete and final accounting of the status of the Plan. Attachment A Out-Of-Area Services The "Out-Of-Area Services" Attachment has been extensively revised in order to meet the new disclosure requirements of the Blue Cross Blue Shield Association. It reads: ATTACHMENT A - OUT-OF-AREA SERVICES As a Licensee of the Blue Cross and Blue Shield Association (BCBSA), the Claims Administrator has arrangements with other Blue Cross and/or Blue Shield Licensees ("Host Blues")for Members care outside the Service Area. These arrangements are called "Inter-Plan Arrangements." The Claims Administrator is required by BCBSA to disclose the information below about these Inter-Plan Arrangements to groups with which the Claims Administrator does business. The Plan Sponsor has consented to this disclosure to permit the Claims Administrator to satisfy its contractual obligations to BCBSA, This provision defines or modifies the rights and obligations of the parties under this Contract only for the processing of claims for care outside the Service Area. The Inter-Plan Arrangements follow rules and procedures set by BCBSA. The Claims Administrator remains responsible to the Plan Sponsor for fulfilling its obligations under this Contract. A Member's receiving services through these Inter-Plan Arrangements does not change covered benefits, benefit levels, or any eligibility requirements of the Plan. The BlueCard®Program is the Inter-Plan Arrangement that applies to most claims from Host Blues' Network Providers. The Host Blue is responsible for contracting and handling all interactions with its Network Providers. Other Inter-Plan Arrangements apply to providers that are not in the Host Blues' networks (Non-Contracted Providers). This Attachment explains how the Plan pays both types of providers. 3 I i Note: The Claims Administrator processes claims for the Prescription Drugs benefit directly, not through an Inter- Plan Arrangement. BlueCard Program Except for copays, the Claims Administrator will base the amount Members must pay for claims from Host Blues' Network Providers on the lower of the provider's billed charge for the covered services or the Allowed Amount that the Host Blue made available to theClaims Administrator. Most often, the Plan Sponsor's liability for those claims is calculated based on the same amount on which the Member's liability is calculated. However, sometimes the Host Blue's Allowed Amount may be greater than the billed charges if the Host Blue has negotiated with a Network Provider an exclusive allowance (such as a per- case or per-day amount) for specific services. This excess amount may be needed to secure (a) the provider's participation in the Host Blue's network and/or(b)the overall discount negotiated by the Host Blue. Because the Member never has to pay more than the billed charge, the Plan Sponsor may be liable for the amount above the provider's billed charge even when the Member's deductible, if any, has not been satisfied. Host Blues determine Allowed Amounts for covered services, which are reflected in the terms of their Network Provider contracts. The Allowed Amount can be one of the following: • An actual price. An actual price is a negotiated amount passed to the Claims Administrator without any other increases or decreases. • An estimated price. An estimated price is a negotiated price that is reduced or increased to take into account certain payments negotiated with the provider and other claim- and non-claim-related transactions. Such transactions may include, but are not limited to, anti-fraud and abuse recoveries, provider refunds not applied on a claim-specific basis, retrospective settlements, and performance-related bonuses or incentives. • An average price. An average price is a percentage of billed charges for the covered services representing the aggregate payments that the Host Blue negotiated with all of its Network Providers or its Network Providers in the same or similar class. It may also include the same types of claim-and non- claim-related transactions as an estimated price. The use of estimated or average pricing may result in a difference between the amount the Plan Sponsor pays on a specific claim and the actual amount the Host Blue pays to the provider. However, the BlueCard Program requires that the Host Blue's Allowed Amount for a claim is final for that claim. No future estimated or average price adjustment will change the pricing of past claims. Any positive or negative differences in estimated or average pricing on a claim are accounted for through variance accounts maintained by the Host Blue and are incorporated into future claim prices. As a result, the amounts to be charged to the Plan Sponsor will be adjusted in a following year, as necessary, to account for over- or underestimation of past years' prices. The Host Blue will not receive compensation from how the estimated or average price methods, described above, are calculated. Because all amounts paid are final, neither variance account funds held to be paid in the following year, nor the funds expected to be received in the following year, are due to or from the Plan Sponsor. If this Contract terminates, the Plan Sponsor will not receive a refund or charge from the variance account. Variance account balances are small amounts compared to overall claims amounts and will be drawn down over time. Some Host Blues may retain interest earned, if any, on funds held in variance accounts. Clark County Providers Services in Clark County, Washington are processed through BlueCard. However, some providers in Clark County do have contracts with the Claims Administrator. These providers will submit claims directly to the Claims Administrator and benefits will be based on the Claims Administrator's Allowed Amount for the covered service or supply. Value-Based Programs Members might receive covered services from providers that participate in a Host Blue's value-based program (VBP). Value-based programs focus on meeting standards for treatment outcomes, cost and quality, and coordinating care when the Member is seeing multiple providers. Some of these programs are similar to those the Claims Administrator has in Washington. Types of value-based programs are accountable care organizations, global payment/total cost of care arrangements, patient-centered medical homes and shared savings arrangements. The Host Blue may pay VBP providers for meeting standards for treatment outcomes, cost and quality, and coordinating care over a period of time called a measurement period. The Claims Administrator then passes 4 1- these payments through to the Plan Sponsor. Sometimes, VBP payments are made before the end of the measurement period. The Host Blue may bill VBP payments for Members in one of two ways: • In the Allowed Amount Host Blues may adjust the Allowed Amount for VBP provider claims to include VBP payments. The actual dollar amount or a small percentage increase may be included. If the VBP pays a fee to the provider for coordinating the Member's care with other providers, the Host Blues may also bill these fees with claims. They will use a separate procedure code for care coordination fees. Members will have to pay a share of VBP payments when Host Blues include VBP charges in claims and a deductible or coinsurance applies to the claim. Members will not be billed for any VBP care coordination fees. Some Host Blues' claims adjustments or PMPM amounts used for VBP payments may be estimates. As a result, these Host Blues hold part of the amounts paid by the Plan Sponsor and Member in a variance account. The Host Blues will use these funds to adjust future VBP payments as explained under"BkieCard Program"above. Taxes, Surcharges And Fees In some cases, a law or regulation may require that a surcharge, tax, or other fee be applied to claims under this Plan. When this occurs, the Claims Administrator will disclose that surcharge; tax or other fee to the Plan Sponsor as part of its liability. Non-Contracted Providers When covered services are provided outside the Claims Administrator's Service Area by Non-Contracted providers, the Allowed Amount will generally be based on either the Claims Administrator's Allowed Amount for these providers or the pricing requirements under applicable law. Members are responsible for the difference between the amount that the Non-Contracted Provider bills and this Plan's payment for the covered services. Please see the definition of"Allowed Amount" in Section 1 in this Contract for details on Allowed Amounts. Return of Overpayments Recoveries of overpayments can arise in several ways. Examples are anti-fraud and abuse recoveries, provider/hospital bill audits, credit balance audits, utilization review refunds, and unsolicited refunds. Recovery amounts will generally be applied on either a claim-by-claim or prospective basis. In some cases, the Host Blue will engage a third party to assist in,identification or collection of recovery amounts. The fees of such a third party may be charged to the Plan Sponsor separately. The fee is usually a percentage of the amount recovered. Unless otherwise agreed to by the Host Blue, the Claims Administrator may request adjustments from the Host Blue for full refunds from providers due to the retroactive cancellation of Members, but never more than one year after the date of the Inter-Plan financial settlement process for the original claim. In some cases, recovery of claim payments associated with retroactive cancellations may not be possible if, as an example, the recovery conflicts with the Host Blue's state law or its provider contracts or would jeopardize its relationship with its providers. BlueCard Worldwide® If Members are outside the United States, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands (the "BlueCard service area"). they may be able to take advantage of BlueCard Worldwide . BlueCard Worldwide is unlike the BlueCard Program available in the BlueCard service area in certain ways. For instance, although BlueCard Worldwide helps Members access a provider network, they will typically have to pay the provider and submit the claims themselves to get reimbursement for covered services. However, if Members need hospital inpatient care, the BlueCard Worldwide Service Center can often direct them to hospitals that will not require them to pay in full at the time of service. These hospitals will also submit the Member's claims to BlueCard Worldwide. Fees and Compensation Network Providers The Plan Sponsor understands and agrees to reimburse the Claims Administrator for certain fees and compensation which the Claims Administrator is obligated under applicable Inter-Plan Programs requirements to pay to the Host Blues, to BCBSA, and/or to Inter-Plan Programs vendors, as described below. The fees may be revised in accordance with Inter-Plan Programs standard procedures, which do not provide for prior approval by any plan sponsor. Such revisions typically are made on January 1, but may occur at any time. Revisions do not necessarily coincide with the Plan Sponsor's benefit period under this Contract. 5 f.- Only the "access fee" can be charged separately each time a claim is processed. The access fee is charged by the Host Blue to the Claims Administrator for making its applicable provider network available to Members. The access fee will only apply to Network Providers'claims. If such a fee is charged, it will be a percentage of the discounUdifferential the Claims Administrator receives from the Host Blue. The access fee will not exceed$2,000 for any claim. All other Inter-Plan Programs-related fees are covered by the Claims Administrator's general administration fee. See "Attachment D- Fees of the Claims Administrator." Non-Contracted Providers All fees related to Non-Contracted Provider claims are covered by the Claims Administrator's general administration fee. Attachment B Census Information The revised Attachment B attached to this Amendment is hereby made a part of the Contract. The spouse and child totals have been combined into a single dependent total. Attachment C Reporting A new paragraph has been added at the end of the Attachment. It reads: If the Plan Sponsor requests a report that includes information not provided in our standard package of reports or a custom format for standard data,we reserve the right to charge the Plan Sponsor an additional fee for that report. I Attachment D Fees Of The Claims Administrator The revised Attachment D attached to this Amendment is hereby made a part of the Contract. Attachment F CareCompass360° The revised Attachment F attached to this Amendment is hereby made a part of the Contract. This attachment now contains the list of Premera's care facilitation services along with any other CareCompass3600 programs that the group has taken. Attachment G Extended Post-Payment Recovery Services The revised Attachment G attached to this Amendment is hereby made a part of the Contract. Attachment H Performance Guarantees The revised Attachment H attached to this Amendment is hereby made a part of the Contract. 6 All other provisions of the Contract remain unchanged. This amendment forms a part of your Contract. Please keep the amendment with your Contract. CITY OF KENT BY', w DATE. /A 131 I ADDRESS: PREMERA BLUE CROSS BY: DATE: January 1, 2017 Jeffrey Roe President and Chief Executive Officer P.O. Box 327 Seattle, WA 98111-0327 i 7 d ATTACHMENT B - CENSUS INFORMATION Administration Fees, effective January 1, 2017, are based on the following: Number of Active Members: Employee Dependents MedicallRx 694 1,148 Other Carriers Offered: Group Health !I 8 F ATTACHMENT D - FEES OF THE CLAIMS ADMINISTRATOR Pursuant to the Administrative Service Contract, the Plan Sponsor shall pay the Claims Administrator the fees, as set forth below, for administrative services. Administration Fees: $59.85 per employee per month The Administration Fee is itemized as follows: Med/RxAdmin. Fee $50.12 B&O Tax $0.83 Network Mgmt. Fee $6.90 Producer Fee $3,00 Electronic EOB credit -$1.00 Total $69.85 Claims Runout Processing Fee: The charge for processing runout claims is an amount equal to the active administration fee at the time of termination, times the average number of subscribers for the 3-month period preceding the termination date, times two. Value-Based Program Payments Provider groups enter into agreements with Premera or other Blue Cross and/or Blue Shield Licensees (Host Blues)for value-based programs. Such programs include the Blue Distinction Total Care program, Global Outcomes Contracts, accountable care organizations, patient-centered medical homes, shared savings arrangements, and global payment/total cost of care arrangements. Premera and the Host Blues may pay value- based program providers for meeting the programs'standards for treatment outcomes, cost, quality and care coordination. The Plan Sponsor shall pay the Claims Administrator a per-member-per month (PMPM) amount established for each value-based program provider group. The PMPM amount will be multiplied by the number of the Plan Sponsor's Members that are attributed to each provider group. The PMPM amounts differ between the provider groups, and may change during the Contract Period. Fee For Class Action Recoveries The Plan Sponsor shall pay the Claims Administrator a fee for its work in pursuing class action recoveries on behalf of the Plan Sponsor as described in Subsection 3.6—Participation in Class Action Suits. The fee shall be a proportionate share of$10,000, based on the proportion of the amount recovered on behalf of the Plan Sponsor compared to the total amount recovered by the Claims Administrator for all lines of business. BlueCard Fee Amount: BlueCard Fees are tracked and billed monthly in addition to claims expense. 9 CareCompass360° Included in Administration Fee. See"Attachment F—CareCompass360°" for an overview of services provided. Extended Post-Payment Recovery Services: Claims Administrator will perform the services listed below on a pay-for-performance, contingent fee ("Contingent Fee") basis,which shall be calculated as a percentage of the gross amount recovered with respect to any particular claim. See "Attachment G— Extended Post-Payment Recovery Services"for an overview of services provided. Post Payment Recovery Contingent Fee Category Coordination of Benefits 25 percent Subrogation 25 percent unless Claims Administrator, in its ts�sole option or discretion, engages outside counsel, in which case the Contingent Fee amount shall be 35 percent, whether or not the case involves litigation or other dispute resolution process. 25 percent if, after Claims Administrator has worked a subrogation case, the Plan Sponsor takes over responsibility for the case and settles directly. In all cases, Plan Sponsor is also responsible for payment of any court costs, such as filing fees, witness fees or court reporter fees. Provider Billing Errors 25 percent Credit Balance 25 percent Hospital Billing and Chart Review 35 percent I 10 p 0 ATTACHMENT F - CARECOMPASS3600 Claims Administrator agrees to make available to the Plan Sponsor certain components of the CareCompass360° program, which are more particularly described in the appendices attached hereto and incorporated herein. Claims Administrator, in its sole and absolute discretion, may upgrade, change Program Managers or otherwise modify these services. Fees for these services are shown in "Attachment D— Fees Of The Claims Administrator..' General Provisions The parties understand, acknowledge and agree that the services provided to the Plan Sponsor hereunder are designed only for availability to the population of Plan Sponsor Members eligible for such services and not for application to each and every Member. • Severability. In the event that any provision hereof is found invalid or unenforceable pursuant to judicial decree or decision, the remainder of this Attachment shall remain valid and enforceable according to its terms. iI 11 I I� ' Appendix 1 Care Facilitation Services Claims Administrator agrees to provide the following care facilitation services. Service Description Care Management Clinical review Prospective and retrospective review for medical necessity, appropriate application of benefits. Includes provision of evidence-based clinical practice and Quality Programs preventive care guidelines to Members and providers, chart tools, and quality of care program activities. . Prescription drug formulary Development of formulary and access to providers and promotion Members oh-line Physician-based pharmacy Physician education on cost-effective prescribing management ePocrates Software to provide physicians with up-to-date drug and plan formulary information. Education for Members using multiple drugs to review Polypharmacy prescriptions with their providers to decrease incidences of adverse drug interactions Follow-up with Members and physicians to minimize Point-of-sale Pharmacy inappropriate or excessive drug therapies identified when drugs are dispensed. Nursel-ine Round-the-clock access for Members to registered nurses to answer questions about their health care. The plan covers telephone and online access to Members' covered health providers when medically appropriate. The Claims Administrator has also contracted with a vendor,to provide telehealth services. The vendor's physicians specialize in family practice, internal medicine or Telehealth Virtual Care pediatrics. Telephone consultations are available through the vendor 24 hours per day, seven (7) days per week. Scheduled video consultations are available between 7:00 a.m. and 9:00 p.m. seven (7) days per week in the time zone of the member. On-demand video consultations are based on provider availability. I I 12 Appendix 2 Personal Health Support Services Services of the Personal Health Support program may include: • Telephonic personal health support, including a clinician designated as the participant's single point of contact for personal health support. Engagement team triage • Periodic reporting on program enrollment and activities Eligible Health Conditions Members eligible for services include those who are classified by Claims Administrator, in its sole discretion, using its own methodology or criteria, as high-risk and/or polychronic(two (2) or more of the chronic conditions designated by Claims Administrator for the program). Claims Administrator may change the methodology for determining eligibility or terms of or criteria for eligibility, at its sole discretion, from time to time. Active Engagement The separate monthly program fee is charged only for Members who are actively engaged in personal health support services during the month. "Active engagement" means that a Member or their authorized designee (such as the parent of a minor child or an individual with power of attorney) has at least one (1) two-way conversation with their personal health support clinician in which health goals are discussed. The initial outreach contact to the Member does not count. No charges are made for a month in which there is no active engagement. i 13 ° Appendix 3 Neonatal Intensive Care Risk Assessment and Case Management The Neonatal Intensive Care Unit (NICU) Program provides case management for babies admitted to the NICU. The program is administered by AlereTM (the "Program Manager"). The Claims Administrator and/or the hospital refers Members who are admitted the NICU or a specialty care nursery to the Program Manager. The Program Manager then contacts the parents to get consent for the newborn Member to participate in the NICU Program. Member participation is voluntary. Services include: • Coordination of care for newborns throughout their stays in the NICU • Assistance with management of the baby's care from discharge to the baby's transition home, Comprehensive booklet that educates parents about the NICU and the needs of the child in the NICU • Measures health outcomes Recommends appropriate levels of care to the Claims Administrator I i I I 14 I i ATTACHMENT H - PERFORMANCE GUARANTEES I i i 15 ATTACHMENT H PERFORMANCE GUARANTEE AGREEMENT BETWEEN Premera Blue Cross of Washington AND City of Kent EFFECTIVE 1/1/2017 THROUGH 12/31/2017 (The "Agreement Period") This Performance Guarantee Agreement is between Premera Blue Cross of Washington ("the Company"), and City of Kent ("the Group"). The Company will provide an acceptable level of service as described herein or will pay the penalties also described herein. SECTION 1. TERM The term of this Agreement shall only be the Agreement Period. Provided this Agreement is executed prior to or on the Effective Date, the Company's fulfillment of the performance guarantees set forth in this Agreement shall be measured from the Effective Date. In the event that this Agreement is not executed prior to or on the Effective Date, the Company's performance shall be measured in accordance with Section 3.C. The performance guarantees under this Agreement are contingent on the Company receiving timely payment of administrative fees or subscription charges, as applicable, from the Group. SECTION 2. PERFORMANCE GUARANTEES AND PENALTY AMOUNTS The Company guarantees its performance as stated below. The maximum amount of accumulated penalties for the Agreement Period shall be $2,600.00 1) Contract Services Booklets Premera will guarantee booklet proofs within 45 business days of receipt of the group renewal confirmation. Additional drafts or final (electronic) booklets will be provided within 10 business days of producer/client edits to initial draft and repeat with each revision as necessary. Printing and mailing of booklets are not subject to - performance guarantee. This metric is non-standard and reporting will be Group specific settled annually ,The estimated penalty for this metric will be $2,600.00 SECTION 3. EVALUATION OF PERFORMANCE AND PAYMENT OF PENALTIES ATTACHMENT H A) At the end of the Agreement, the Company shall compile the necessary documentation and perform the necessary calculations to evaluate its fulfillment of each performance guarantee set forth in this Agreement and make this information available to the Group. B) If the Company fails to meet any of the performance guarantees set forth in Section 2, the Company shall pay to the Group the financial penalty based on the percentage set forth in Section 2. C) In the event that this Agreement is not executed by the Effective Date, the Company's performance shall be measured from the first day of the month following the month this Agreement is executed. In such event the applicable penalty amounts will be pro-rated for that portion of the year for which performance guarantee metrics are in force. D) Refer to Section 4 if the contract under which the Company provides insurance and/or administrative services to the Group is terminated prior to the end of the term of this Agreement. SECTION 4. TERMINATION OF AGREEMENT If this Agreement terminates prior to the last day of the Agreement Period the Group is not entitled to any penalties under Section 2 of this Agreement. This Agreement shall terminate upon the earliest of the following dates: A) the end of the Term of this Agreement; B) the effective date of any state's or other jurisdiction's action which prohibits activities of the parties under this Agreement; C) the date upon which the Group either fails to meet its obligation to sufficiently fund the bank account from which claims are paid (if applicable), or fails to make timely payments of either administrative fees or subscription charges anytime during the plan year; D) the date upon which the contract under which the Company provides services to the Group is terminated; E) any other date mutually agreeable to the Company and Group.