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Except as herein modified and amended, the provisions, conditions and terms of the Agreement shall <br /> remain full force and effect. By executing this Amendment,the Parties hereby consent to all of the terms <br /> and conditions herein and in the Agreement. <br /> IN WITNESS WHEREOF, the Parties hereto have executed this Amendment as of the date and year <br /> specified below. <br /> BLUE CROSS AND BLUE SHIELD OF ILLINOIS, CITY OF DECATUR("EMPLOYER") <br /> a Division of Health Care Service Corporation, <br /> a Mutual Legal Reserve Company <br /> 6J34 r <br /> By: By: <br /> Title: Divisional SVP and Chief Underwriter Title: <br /> Date: Effective Date of Coverage noted above Date: <br /> IL Gen Med-CF Non-ERISA ASA Amendment Rev.7.24 <br /> 4 <br /> Proprietary and Confidential Information of Claim Administrator <br /> Not for use or disclosure outside Claim Administrator,Employer,their respective affiliated companies,and <br /> third-party representatives,except with written permission of Claim Administrator. <br />