2Purpose and Scope. The purpose of this Contract is to establish Contractor as a provider of SEBB Medical Plan(s), as described in this agreement, for the School Employees Benefits Board (SEBB) Program, in which the Contractor will assume financial responsibility for their Members' medical Claims and for all incurred administrative costs. The following categories of services that Contractor will provide to HCA, all as more fully described in this Contract and all exhibits and attachments hereto are:
2Purpose and Scope. This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following: • What will be monitored • How monitoring will take place • Who will conduct the monitoring • How monitoring efforts and results will be documented This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance. In addition, the QASP should recognize that unforeseen and uncontrollable situations may occur. This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government will coordinate changes with the contractor. Updates will ensure that the QASP remains a valid, useful, and enforceable document. Copies of the original QASP and revisions will be retained in the contract file. Section 2Roles and Responsibilities
2Purpose and Scope. The purpose of this Contract is to establish Contractor as a provider of SEBB Medical Plan(s), as described in this agreement, for the School Employees Benefits Board (SEBB) Program, in which the Contractor will assume financial responsibility for their Members' medical Claims and for all incurred administrative costs. The following categories of services that Contractor will provide to HCA, all as more fully described in this Contract and all exhibits and attachments hereto are: Benefits Services - This includes, but is not limited to: providing benefits in accordance with the Certificate of Coverage in effect during the Contract year, Clinical Management, Utilization Management, Chronic Condition Management, Case Management, and Health Savings Account (HSA) administration. Administrative Services - This includes, but is not limited to: implementation, Claims administration, customer service provided via toll-free line and fax lines, Member communications including mailing of members' materials and identification cards, online services, and processing Appeals and Complaints. Health Transformation Services - This includes, but is not limited to: rewarding patient-centered, high value care; improving quality outcomes and patient experience; driving standardization based on evidence and best-practice recommendations; striving for the Triple Aim; and implementing purchasing strategies that align with HCA’s purchasing goals.
