R2010-233 AUTHORIZING AGREEMENT - Laserfiche WebLink

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, B. Retiree Only Plans, Excepted Benefits and/or Self-Insured Nonfederal Governmental Plans: If the BPA includes any retiree oniy plans, excepted benefits and/or self-insured nonfederal governmental plans (with an exemption election), then Employer represents and warrants that one or more such plans is not subject to some or all of the provisions of Part A(Individual and Group Market Reforms) of Title XXVII of the Public Health Service Act(and/or related provisions in the Internal Revenue Code and Employee Retirement Income Security Act) (an "exempt plan status"). Any determination that a plan does not have exempt plan status can resuit in retroactive and/or prospective changes by Claim Administrator to the terms and conditions of administrative services. In no event shall Claim Administrator be responsible for any legal, tax or other ramifications related to any plan's exempt plan status or any representation regarding any plan's exempt plan status. C. Employer shall indemnify and hold harmless Claim Administrator and its directors, officers and employees against any and all loss, liability, damages, fines, penalties, taxes, expenses (including attorneys' fees and costs) or other costs or obligations resulting from or arising out of any claims, lawsuits, demands, governmental inquires or actions, settlements or judgments brought or asserted against Claim Administrator in connection with (a) any plan's grandfathered health plan status, (b) any plan's exempt plan status, (c) any plan's design (including but not limited to any directions, actions and interpretations of the Employer), and/or(d) any provision of inaccurate information. Changes in state or federal law or regulations or interpretations thereof may change the terms and conditions of administrative services. The provisions of paragraphs A-C (directly above) shall be in addition to (and do not take the place o� the other terms and conditions of administrative services between the parties. Group is changing their status to a non-Grandfathered Group eff. 1/1/2012 - all ACA mandated rulings will apply. Group will comply with the Civil Union Laws. Group# P22346-changing deductible. to$200 per cal yr-changing OPX to$1,250 - Deductible will be included in the OPX limit of$1,250. This is the last year for Open Enrollment for this group number. Penny Dunlevy Sales Representative Sign e of Authori d Purchaser 848/629 217-725-8533 � R � ', District Phone&FAX Numbers Title ��, John Malachowski ` ��/2� ��p /f �I Producer Representa ve Date � Gallagher Benefit Servi es, Inc. Producer Firm 101 South Main Street, Suite 200, Decatur, IL 62523 Producer Address 217-423-2345 (P) - (F) -217-233-3332 Producer Phone&FAX Numbers jmalachowski@behnkeins.com Producer Email Address 37-1139471 Tax I.D. No. HCSC IL GEN ASO BPA Rev. 9.1.10(On-line Version) page 10