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ti <br /> . . BlueCross BlueShield of II(inois <br /> I�� � <br /> EARLY RETIREE REINSURANCE PROGRAM <br /> DATA EXCHANGE AND SERVICE AGREEMENT <br /> l. PURPOSE <br /> This agreement (the "Agreement") is made as of �/�a/zo�i (the "Effective Date") by and <br /> between Blue Cross and Blue Shield of Ilfinois, a Division of Health Care Service Corporation, <br /> a Mutual Legal Reserve Company ("HCSC") and city ofDecatur the Employer and/or Sponsor of <br /> one or more Group Health Plans that offer Health Benefits coverage to early retirees and their <br /> dependents ("Employer"), for the purpose of delineating the terms and conditions for the <br /> informati�n and data exchanges and other services that HCSC will provide related to <br /> Employer's participation in the federal early retiree reinsurance program ("ERR Program") <br /> established by Section 1102 of the Patient Protection and Affordable Care Act and <br /> administered by the U. S. Department of Health & Human Services (HHS). <br /> It. DEFINtTIONS <br /> A. The terms "Benefit Options," "Chronic and High-Cost Condition," "Claim," "Early Retiree," <br /> "Group Health Plan," "Health Benefits," "(ncurred," "Negotiated Price Concession," "Plan <br /> Year," and "Post-Point-of-Sale Negotiated Price Concession" shall have the same meaning <br /> as in 45 C.F.R. §149.2, and as such terms may be finally adopted, re-codified, renumbered <br /> and clarified or expanded by HHS guidance. <br /> B. The term "HIPAA" means the Health Insurance Portability and Accountability Act of 1996, <br /> as amended, and the regulations promulgated pursuant to that act. <br /> C. The term "List of Early Retir.ees" means a list or other identification �mechanism for each <br /> reporting period of all individuals Employer believes (using information reasonably available <br /> to Employer) are Early Retirees (including spouses, dependents, and surviving spouses) <br /> enrolled in any Benefit Option under Employer's Group Health Plan for which HCSC <br /> provides claims administrative services and that is submitted to HHS as required by 45 <br /> C.F.R. §149.335(a). <br /> D. The term "Reported Claim" shall have the same meaning as "Claim" above, and: <br /> 1. shall be limited to Claim(s) only under Benefit Options for which HCSC provides claims <br /> administrative services; <br /> 2. shall specifically include, consistent with 45 C.F.R. §149.2, all Negotiated Price <br /> Concessions known at the time of reporting by HCSC to Employer, and may be subject <br /> to later update due to any claims reversals, Post-Point-of-Sale Negotiated Price <br /> Concessions, or other inaccuracy known to HCSC; and <br /> 3. with respect to any Claim that is incurred and paid under a capitation or similar <br /> arrangement that does not ordinarify result in a claims form, shall reflect costs <br /> determined by HCSC as reasonable in light of the specific market and as permitted by <br /> guidance from HHS. <br /> � i3iY�isicf�� t�f E;�,�li��:a��e�c:r€�ic��Carpat•atis�a7,a �ttc�iixa! i.e�al �'��=ser����C'om�7�n�-, <br /> An incit��ea�d�nt Lzcezzss�of Ehe I3iue£�`ross and T;lcte 5hieid 1.ssoeia�icsn <br /> ASO ERR PROGRAM MASTER 06/10 <br />