Product SLA
DEFINITIONS:
Business Days shall mean Monday through Friday, excluding the following holidays: New Year’s Day, Martin Luther King Day, President’s Day, Memorial Day, Independence Day (observed), Labor Day, Columbus Day, Veteran’s Day, Thanksgiving Day, day after Thanksgiving, Christmas Eve, Christmas Day and New Year’s Eve.
Credits shall mean that, provided that the printed product(s) being produced do not exceed the Client’s Routine Daily Volume (defined herein), and Client is in compliance with the terms and conditions of the Agreement (including without limitation its obligations specified in this Exhibit), then printed products not mailed in their specific Business Day turnaround time shall result in a credit to Client equal to 5% of the cost of the package rate not produced and mailed within their specific Business Day turnaround time as incorporated below. The credit percentage is calculated based upon the per unit charge of the applicable printed product(s) which were not mailed within their specific Business Day turnaround time and does not include postage or other fees.
Daily Defined Capacity shall mean either the Routine Daily Volume or the Peak Average Daily Volume. Volumes sent in excess of the “Daily Defined Capacity” for a given production day, the SLA shall be extended by one (1) Business Day for each incremental daily defined capacity.
FIFO shall mean First in First Out and is based on the Print ID creation date. PIDs are generated as a result of Client file processing and/or process approvals. The Print ID date is located under File Detail within the Clarity application.
Job ID shall mean a unique number assigned by the Clarity application system to each file received by Clarity. A Job ID may include one or many Print ID’s (defined herein). The Job ID is used to identify the client’s corresponding data file that was transmitted to Clarity.
Medicare Peak Average Daily Volume shall mean Client’s total Medicare Peak Period volume from the previous year that was sent to print production plus Projected Growth volume, divided by total Business Days during the Medicare Peak Period.
Medicare Peak Period shall mean the time period from October 15 through November 29.
Non-Peak Period shall mean the time period from January 16 through November 29.
Peak Average Daily Volume shall mean Client’s total Peak Period volume from the previous year that was sent to print production plus Projected Growth volume, divided by total Business Days during the Peak Period.
Peak Period shall mean the time period from November 30 through January 15.
Print ID shall mean when a full file is received at Clarity, the packages created from that file are stratified into Print ID’s, which are used to group “like with like” package types to streamline print streams and enforce print production constraints on those print streams. The attributes of packages within a Print ID might be as simple as all being comprised of the same materials (i.e., an ID Card package), or could be more complex depending on the contents of the packages that are generated by the file (i.e., an ID Card package plus 2 preprinted inserts). Print IDs are enforced with maximum thresholds to optimize print machinery and digital responsiveness for Web Service transactions. Print IDs are only created when records from the Job ID are fully processed, meaning the record was either “not held” via PCS, or approved from a PCS hold. A Print ID would not be created if a record fell to error or was rejected from a hold.
Production Quality shall mean that Clarity will ensure that all print products will be free in all material respects of cosmetic print defects, including: no smudges or loss of information. Any printed product produced with these quality issues, shall result in a credit of 5% of the cost of the applicable product(s) with the quality issues, as well as the reproduction of those products at Clarity’s cost. The aggregate credits issued hereunder shall not exceed the fees paid by Client under this SOW.
Projected Growth shall mean clients forecasted package increase based on new groups and business, excluding outliers or non-annual activity (i.e. reissues).
Reasonable Effort shall mean best effort and mutually agreeable between parties.
Routine Daily Volume shall mean the volume calculated from total average weekly print production volume during Non-Peak Period, if applicable, divided by number of Business Days per week. The weekly averages for the previous three (3) years are used for this calculation.
Turnaround Time shall mean, for example: Client sends a complete data file on or before the 5 a.m. EST approved File Receipt Time on a Tuesday which is a Business Day during a non-holiday week. The Print ID Card has a 2 Business Day turnaround time. Tuesday is day zero in this example and the Print ID Card would be mailed not later than 2 Business Days thereafter, i.e., Thursday.
1095-B
Service Levels
Clarity relies on the accuracy of the data it receives from Client, and Client agrees to provide accurate, timely and complete information to Clarity for processing. Complete, error-free 1095-B data files with Client Materials submitted by Client using the agreed SFTP protocol, and successfully received by Clarity prior to 5:00 a.m. Eastern Standard Time (EST) on a Business Day (“File Receipt Time”), and that do not require review, validation, or corrections, shall be considered a successful receipt and the date of receipt shall then be counted as Day Zero (0) for measurement of turnaround time. Incomplete data files or data files unable to be processed due to Client error or oversight are not considered complete and error-free. Files received after 5:00 a.m. EST which are complete and error-free shall be counted as Day Zero on the first Business Day after receipt.
Print 1095-B Turnaround Time
All Printed 1095-B requests shall be produced and mailed to the individual identified in Part I of the Form 1095-B in accordance with the Information Reporting due dates published by the Department of Treasury Internal Revenue Service for each tax year that is applicable to the Client.
Clarity will also electronically file with the IRS, using an IRS sanctioned transmission channel, the Form(s) 1094-B, Transmittal of Health Coverage Information Returns, and the Form(s) 1095-B, Health Coverage in accordance with the Information Reporting due dates published by the Department of Treasury Internal Revenue Service for each tax year that is applicable to the Client. Clarity will also electronically file with the appropriate states using their published transmission channel/process, if applicable.
Digital 1095-B Availability
All Digital 1095-Bs will be available for retrieval via Web Services as soon as processing is completed.
Capacity
For the purposes of planning for and providing sufficient production capacity, Client agrees to provide at least five (5) Business Days’ notice to Clarity when the projected volume capacity may exceed 125% of Client’s Routine Daily Volume. When this capacity is exceeded, Clarity will employ a first in, first out method to any overflow data files submitted by Client, up to the Client’s Routine Daily Volume, unless additional capacity has been approved in writing by Clarity in advance. If the volume exceeds the Client’s Routine Daily Volume, Clarity will use reasonable efforts to meet the Turnaround Time; however excess capacity is not eligible for the credits described in the Credit section.
ANOC
Service Levels
Clarity relies on the accuracy of the data it receives from Client, and Client agrees to provide accurate, timely and complete information to Clarity for processing. Complete, error-free ANOC data files with Client Materials submitted by Client using the agreed SFTP protocol, and successfully received by Clarity prior to 5:00 a.m. Eastern Standard Time (EST) on a Business Day (“File Receipt Time”), and that do not require review, validation, or corrections, shall be considered a successful receipt and the date of receipt shall then be counted as Day Zero (0) for measurement of turnaround time. Incomplete data files or data files unable to be processed due to Client error or oversight are not considered complete and error-free. Files received after 5:00 a.m. EST which are complete and error-free shall be counted as Day Zero on the first Business Day after receipt.
Printed ANOC Turnaround Time
Clarity will provide a timeline in advance for each year’s deadlines for each Client task associated with ANOC production. All Printed ANOC requests shall be produced and mailed for receipt by members on or prior to September 30th of each year so long as Clients meet the required task deadlines.
Digital ANOC Availability
All Digital ANOCs will be available for retrieval via Web Services as soon as processing is completed.
Capacity
For the purposes of planning for and providing sufficient production capacity, Client agrees to provide at least five (5) Business Days’ notice to Clarity when the projected volume capacity may exceed 125% of Client’s Routine Daily Volume. When this capacity is exceeded, Clarity will employ a first in, first out method to any overflow data files submitted by Client, up to the Client’s Routine Daily Volume, unless additional capacity has been approved in writing by Clarity in advance. If the volume exceeds the Client’s Routine Daily Volume, Clarity will use reasonable efforts to meet the Turnaround Time; however excess capacity is not eligible for the credits described in the Credit section.
EXPLANATION OF BENEFITS (EOB)
Service Levels
Clarity relies on the accuracy of the data it receives from Client, and Client agrees to provide accurate, timely and complete information to Clarity for processing. Complete, error-free data files with Client Materials shall be submitted by Client using the agreed secured SFTP protocol, and successfully received by Clarity prior to 5:00 a.m. Eastern Standard Time (EST) on a Business Day (“File Receipt Time”), and that do not require review, validation, or corrections, shall be considered a successful receipt and the date of receipt shall then be counted as Day Zero (0) for measurement of turnaround time. Incomplete data files or data files unable to be processed due to Client error or oversight are not considered complete and error-free. Files received after 5:00 a.m. EST which are complete and error-free shall be counted as Day Zero on the first Business Day after receipt.
Printed EOB Turnaround Time
All Printed EOB requests shall be produced and mailed within three (3) Business Days of File Receipt Time.
Digital EOB Availability
All Digital EOBs will be available for retrieval via Web Services as soon as processing is completed.
Capacity
For the purposes of planning for and providing sufficient production capacity, Client agrees to provide at least five (5) Business Days’ notice to Clarity when the projected volume capacity may exceed 125% of Client’s Routine Daily Volume. When this capacity is exceeded, Clarity will employ a first in, first out method to any overflow data files submitted by Client, up to the Client’s Routine Daily Volume, unless additional capacity has been approved in writing by Clarity in advance. If the volume exceeds the Client’s Routine Daily Volume, Clarity will use reasonable efforts to meet the Turnaround Time; however excess capacity is not eligible for the credits described in the Credit section.
ID CARDS
Service Levels
Clarity relies on the accuracy of the data it receives from Client, and Client agrees to provide accurate, timely and complete information to Clarity for processing. Complete, error-free ID card data files with Client Materials submitted by Client using the agreed SFTP protocol, and successfully received by Clarity prior to 5:00 a.m. Eastern Standard Time (EST) on a Business Day (“File Receipt Time”), and that do not require review, validation, or corrections, shall be considered a successful receipt and the date of receipt shall then be counted as Day Zero (0) for measurement of turnaround time. Incomplete data files or data files unable to be processed due to Client error or oversight are not considered complete and error-free. Files received after 5:00 a.m. EST which are complete and error-free shall be counted as Day Zero on the first Business Day after receipt.
Printed ID Card Turnaround Time
All Printed ID Card requests during Non-Peak Period, up to a maximum of 125% of Client’s Routine Daily Volume per Business Day, measured each week of the calendar year shall be produced and mailed within two (2) Business Days of File Receipt Time. All requests during Peak Period, up to a maximum of Client’s prior year Peak Average Daily Volume, or during Medicare Peak Period, up to a maximum of Client’s prior year Medicare Peak Average Daily Volume shall be produced and mailed within two (2) Business Days of File Receipt Time.
Digital ID Card Availability
All Digital ID Cards will be available for retrieval via Web Services as soon as processing is completed.
Capacity
For the purposes of planning for and providing sufficient production capacity, Client agrees to provide at least five (5) Business Days’ notice to Clarity when the projected volume capacity may exceed 125% of Client’s Routine Daily Volume during Non-Peak Period –or– thirty (30) Business Days’ notice when the projected volume capacity may exceed the Peak Average Daily Volume plus the client’s Projected Growth. Client shall provide Projected Growth by March 31st for the upcoming Peak Period and Medicare Peak Period. In return, Clarity will provide Routine Daily Volume for calendar year. When either of these capacities are exceeded, Clarity will employ a FIFO method to any overflow data files submitted by Client, up to the amount of Client’s defined capacity for the given period, unless additional capacity has been approved in writing by Clarity in advance. If the volume exceeds the Client’s defined capacity as measured for Peak or Non-Peak activity, Clarity will use Reasonable Efforts to meet the Turnaround Time; however, any excess of the Client’s defined capacity for the given period are not eligible for the credits described in the Credit section unless Clarity and the Client mutually agree on a set schedule provided per notices listed above.
INVOICES/1099’s
Service Levels
Clarity relies on the accuracy of the data it receives from Client, and Client agrees to provide accurate, timely and complete information to Clarity for processing. Complete, error-free data files with Client Materials shall be submitted by Client using the agreed secured SFTP protocol, and successfully received by Clarity prior to 5:00 a.m. Eastern Standard Time (EST) on a Business Day (“File Receipt Time”), and that do not require review, validation, or corrections, shall be considered a successful receipt and the date of receipt shall then be counted as Day Zero (0) for measurement of turnaround time. Incomplete data files or data files unable to be processed due to Client error or oversight are not considered complete and error-free. Files received after 5:00 a.m. EST which are complete and error-free shall be counted as Day Zero on the first Business Day after receipt.
Printed Invoice Turnaround Time
All Printed Invoice requests shall be produced and mailed within three (3) Business Day of File Receipt Time.
Digital Invoice Availability
All Digital Invoices will be available for retrieval via Web Services as soon as processing is completed.
Capacity
For the purposes of planning for and providing sufficient production capacity, Client agrees to provide at least five (5) Business Days’ notice to Clarity when the projected volume capacity may exceed 125% of Client’s Routine Daily Volume. When this capacity is exceeded, Clarity will employ a first in, first out method to any overflow data files submitted by Client, up to the Client’s Routine Daily Volume, unless additional capacity has been approved in writing by Clarity in advance. If the volume exceeds the Client’s Routine Daily Volume, Clarity will use reasonable efforts to meet the Turnaround Time; however excess capacity is not eligible for the credits described in the Credit section.
LETTERS
Service Levels
Clarity relies on the accuracy of the data it receives from Client, and Client agrees to provide accurate, timely and complete information to Clarity for processing. Complete, error-free data files with Client Materials shall be submitted by Client using the agreed secured SFTP protocol, and successfully received by Clarity prior to 5:00 a.m. Eastern Standard Time (EST) on a Business Day (“File Receipt Time”), and that do not require review, validation, or corrections, shall be considered a successful receipt and the date of receipt shall then be counted as Day Zero (0) for measurement of turnaround time. Incomplete data files or data files unable to be processed due to Client error or oversight are not considered complete and error-free. Files received after 5:00 a.m. EST which are complete and error-free shall be counted as Day Zero on the first Business Day after receipt.
Turnaround Time
All Printed Letter requests shall be produced and mailed within three (3) Business Days of File Receipt Time.
Digital Letter Availability
All Digital Letters will be available for retrieval via Web Services as soon as processing is completed.
Capacity
For the purposes of planning for and providing sufficient production capacity, Client agrees to provide at least five (5) Business Days’ notice to Clarity when the projected volume capacity may exceed 125% of Client’s Routine Daily Volume. When this capacity is exceeded, Clarity will employ a first in, first out method to any overflow data files submitted by Client, up to the Client’s Routine Daily Volume, unless additional capacity has been approved in writing by Clarity in advance. If the volume exceeds the Client’s Routine Daily Volume, Clarity will use reasonable efforts to meet the Turnaround Time; however excess capacity is not eligible for the credits described in the Credit section.
UTILIZATION MANAGEMENT “UM” LETTERS
Service Levels
Clarity relies on the accuracy of the data it receives from Client, and Client agrees to provide accurate, timely and complete information to Clarity for processing. Complete, error-free data files with Client Materials shall be submitted by Client using the agreed secured SFTP protocol, and successfully received by Clarity prior to 5:00 p.m. Eastern Standard Time (EST) (“File Receipt Time”), and that do not require review, validation, or corrections, shall be considered a successful receipt and the date of receipt shall then be counted as Day Zero (0) for measurement of turnaround time. Incomplete data files or data files unable to be processed due to Client error or oversight are not considered complete and error-free. Files received after 5:00.p.m. EST which are complete and error-free shall be counted as Day Zero on the following day.
Printed UM Letter Turnaround Time
For Printed UM Letters, Clarity will process, produce, and mail up to 15,000 packages per day (Day Zero), provided the files are received by the File Receipt Time.
Digital UM Letter Availability
All Digital UM Letters will be available for retrieval via Web Services as soon as processing is completed.
Capacity
For the purposes of planning for and providing sufficient production capacity, Client agrees to provide at least five (5) Business Days’ notice to Clarity when the projected volume capacity may exceed 125% of Client’s Routine Daily Volume. When this capacity is exceeded, Clarity will employ a first in, first out method to any overflow data files submitted by Client, up to the Client’s Routine Daily Volume, unless additional capacity has been approved in writing by Clarity in advance. If the volume exceeds the Client’s Routine Daily Volume, Clarity will use reasonable efforts to meet the Turnaround Time; however excess capacity is not eligible for the credits described in the Credit section.
MEMBER GUIDES
Service Levels
Clarity relies on the accuracy of the data it receives from Client, and Client agrees to provide accurate, timely and complete information to Clarity for processing. Complete, error-free data files with Client Materials shall be submitted by Client using the agreed secured SFTP protocol, and successfully received by Clarity prior to 5:00 a.m. Eastern Standard Time (EST) on a Business Day (“File Receipt Time”), and that do not require review, validation, or corrections, shall be considered a successful receipt and the date of receipt shall then be counted as Day Zero (0) for measurement of turnaround time. Incomplete data files or data files unable to be processed due to Client error or oversight are not considered complete and error-free. Files received after 5:00 a.m. EST which are complete and error-free shall be counted as Day Zero on the first Business Day after receipt.
Printed Member Guide Turnaround Time
All Printed Member Guide requests during Non-Peak Period, up to a maximum of 125% of Client’s Routine Daily Volume per Business Day, measured each week of the calendar year shall be produced and mailed within three (3) Business Days of File Receipt Time. All requests during Peak Period, up to a maximum of Client’s prior year Peak Average Daily Volume, or during Medicare Peak Period, up to a maximum of Client’s prior year Medicare Peak Average Daily Volume shall be produced and mailed within three (3) Business Days of File Receipt Time.
Digital Member Guide Availability
All Digital Member Guides will be available for retrieval via Web Services as soon as processing is completed.
Capacity
For the purposes of planning for and providing sufficient production capacity, Client agrees to provide at least five (5) Business Days’ notice to Clarity when the projected volume capacity may exceed 125% of Client’s Routine Daily Volume during Non-Peak Period –or– thirty (30) Business Days’ notice when the projected volume capacity may exceed the Peak Average Daily Volume plus the client’s Projected Growth. Client shall provide Projected Growth by March 31st for the upcoming Peak Period and Medicare Peak Period. In return, Clarity will provide Routine Daily Volume for calendar year. When either of these capacities are exceeded, Clarity will employ a FIFO method to any overflow data files submitted by Client, up to the amount of Client’s defined capacity for the given period, unless additional capacity has been approved in writing by Clarity in advance. If the volume exceeds the Client’s defined capacity as measured for Peak or Non-Peak activity, Clarity will use Reasonable Efforts to meet the Turnaround Time; however, any excess of the Client’s defined capacity for the given period are not eligible for the credits described in the Credit section unless Clarity and the Client mutually agree on a set schedule provided per notices listed above.
MEMBER KITS
Service Levels
Clarity relies on the accuracy of the data it receives from Client, and Client agrees to provide accurate, timely and complete information to Clarity for processing. Complete, error-free data files with Client Materials shall be submitted by Client using the agreed secured SFTP protocol, and successfully received by Clarity prior to 5:00 a.m. Eastern Standard Time (EST) on a Business Day (“File Receipt Time”), and that do not require review, validation, or corrections, shall be considered a successful receipt and the date of receipt shall then be counted as Day Zero (0) for measurement of turnaround time. Incomplete data files or data files unable to be processed due to Client error or oversight are not considered complete and error-free. Files received after 5:00 a.m. EST which are complete and error-free shall be counted as Day Zero on the first Business Day after receipt.
Printed Member Kit Turnaround Time
All Printed Member Kit requests during Non-Peak Period, up to a maximum of 125% of Client’s Routine Daily Volume per Business Day, measured each week of the calendar year shall be produced and mailed within three (3) Business Days of File Receipt Time. All requests during Peak Period, up to a maximum of 225% of Client’s Routine Daily Volume, shall be produced and mailed within three (3) Business Days of successful receipt of the Client Materials by Clarity. Routine Daily Volume is calculated based on Client’s weekly average production volume for any given week of the month, divided by the number of Business Days in that week during the Non-Peak Period.
Digital Member Kit Availability
All Digital Member Kits will be available for retrieval via Web Services as soon as processing is completed.
Capacity
For the purposes of planning for and providing sufficient production capacity, Client agrees to provide at least five (5) Business Days’ notice to Clarity when the projected volume capacity may exceed 125% of Client’s Routine Daily Volume during Non-Peak Period –or– thirty (30) Business Days’ notice when the projected volume capacity may exceed the Peak Average Daily Volume plus the client’s Projected Growth. Client shall provide Projected Growth by March 31st for the upcoming Peak Period and Medicare Peak Period. In return, Clarity will provide Routine Daily Volume for calendar year. When either of these capacities are exceeded, Clarity will employ a FIFO method to any overflow data files submitted by Client, up to the amount of Client’s defined capacity for the given period, unless additional capacity has been approved in writing by Clarity in advance. If the volume exceeds the Client’s defined capacity as measured for Peak or Non-Peak activity, Clarity will use Reasonable Efforts to meet the Turnaround Time; however, any excess of the Client’s defined capacity for the given period are not eligible for the credits described in the Credit section unless Clarity and the Client mutually agree on a set schedule provided per notices listed above.
WEB SERVICES
“Web System” is defined herein as “the proprietary Clarity application and Pre-Existing IP to be made available for use by Client related to the Services in this Exhibit”. Clarity will provide its proprietary Web System application to support the management, production and presentment of Client’s E-Delivery Materials (as applicable per this agreement). The Web System will allow Client to create, pre-view, and track materials processed by Clarity.
Web System Access for Use By Client
Clarity’s Web System is available 24 hours a day, 7 days a week, except during scheduled maintenance. Clarity will perform scheduled maintenance from 9:00 p.m. Tuesday until 2:00 a.m. EST Wednesday, and between 12:00 a.m. and 6:00 a.m. EST on Saturdays. Clarity reserves the right to perform emergency maintenance outside of these scheduled maintenance hours if circumstances require.
Web services are updated annually. Client must cooperate with Clarity to ensure these new releases are incorporated within a mutually agreeable time frame. In order to facilitate this change, Clients are required to coordinate with all Client’s internal teams that depend on Clarity web services.
Reporting
The proprietary Clarity dashboard will be made available to Client through the Web System, which includes information and metrics on Client Materials. Client may run Clarity standard reports from the Web System.
DIGITAL WALLET
Digital Wallet Availability
All products will be available in the digital wallet as soon as processing is completed.