R2010-233 AUTHORIZING AGREEMENT - Laserfiche WebLink

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- Reimbursement Provision: � Yes ❑ No If yes: It is understood and agreed that in the event the Claim Administrator makes a recovery on a third-party liability claim, the Claim Administrator will retain 25% of any recovered amounts other than recovered amounts received as a result of or associated with an Workers' Com ensation Law. Conversion Privilege: ❑ Yes � No If yes, conversion fee: $6,000 per conversion. Blue Care Connection (`BCC") Program BCC Package: Enhanced Fee: $ included in admin fee per Covered Employee per month for administration of the program package. BCC Package Upgrade(s): Description: Fee: $ per Covered Employee per month for administration of the package upgrade. Description: Fee: $ per Covered Employee per month for administration of the package upgrade. Ancillary Program: Select from Pull Down • � • • - As applies to the Run-Off Period indicated in the Payment Specifications section below: i. For service charges (including, but not limited to, access fees) billed on a per Covered Employee basis at the time of termination, the Termination Administrative Charge will be the amount equal to ten percent (10%) of the annualized charges based on the service charges in effect as of the termination date and the Plan participation of the finro (2) months immediately preceding the termination date. Such aggregate amount will be due the Claim Administrator within ten (10) days of the Claim Administrator's notification to the Employer of the Termination Administrative Charge described herein. ii. For service charges (including, but not limited to, access fees) billed on a basis other than per Covered Employee at the time of termination, the Termination Administrative Charge will be such service charges in effect at the time of termination to be applied and billed by the Claim Administrator, and paid by the Employer, in the same manner as prior to termination. Termination Administrative Charges assume the continuation of the Plan benefit program(s) and the administrative services in effect prior to termination. Should such Plan benefit program(s) and/or administrative services change, or in the event the average Plan enrollment during the three (3) months immediately preceding termination varies by ten percent (10%) or more from the enrollment used to determine the service charges in effect at the time of termination, the Claim Administrator reserves the right to adjust the rates for service charges (including, but not limited to, access fees) to be used to compute the Termination Administrative Charge. ' • • Employer Payment Method: ❑ Online Bill Pay �Electro� -�-ehgt.�" Employer Payment Period: ❑Weekly (cannot be se/ected if Check is selected as payment method above) ❑ Twice-Monthly � Monthly ❑ Other(please specify): Claim Settlement Period: � Monthly ❑ Other(please specify): Run-Off Period Employer Payments are to be made for 12 months following end of Fee Schedule Period. Standard is twelve (12) months. Final Settlement: Final Settlement is to be made within 60 days after end of Run-Off Period. Standard is sixty(60) days. HCSC IL GEN ASO BPA Rev. 9.1.10(On-line Version) page 5