Common use of Value-add Services Clause in Contracts

Value-add Services. ‌ Insurer may offer value-add services at no cost to FHKC or Enrollees. Insurer shall offer any value-add services proposed during the ITN process and listed in Attachment A. Insurer shall submit any proposed value-add services, including a description of the eligible population and any limitations, to FHKC for approval. Insurer must request and receive FHKC approval to discontinue any value-add services. Unless approved by FHKC in writing, value-add services shall be offered for at least one (1) complete Contract Year and shall not be discontinued during a Contract Year. Any value-add services proposed during the ITN and included in this Contract are considered material to the competitive ITN process. As such, Insurer shall not discontinue these value-add services without replacing the value-add service with an equivalent value-add service, subject to FHKC approval. An equivalent value-add service must be relevant to the Program and must be expected to fulfill similar needs for Enrollees regarding the number of Enrollees potentially impacted and the level of care. Requests for changes to value-add service shall be submitted to FHKC for consideration annually on July 1. Insurer shall provide Enrollees with notice of any value-add service changes at least ninety (90) Calendar Days in advance of such changes. If a value-added service is provided in lieu of a Covered Service or setting required in this Contract: a. Such service is subject to FHKC’s determination that the alternative service or setting is medically appropriate and cost effective; b. Enrollees are not required to use the alternative service or setting; c. The alternative services or setting are authorized and identified in this Contract; and d. The utilization and actual cost of the alternative services or setting are taken into account when developing the premium rates in accordance with 42 CFR 457.1201(e) and 42 CFR 438.3(e)(2)(iv). Insurer shall include all value-add services in Insurer’s Enrollee handbook.