R2007-236 AUTHORIZING AGREEMENT WITH BLUE CROSS BLUE SHIELD OF ILLINOIS

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' a' ti � LXIIII3I'1'2 I�EI?SCIILllULL, I�'INANCIAL RLSYONSII;ILI"1'IES & 1LEQUIRLll 1)ISCLOSUREti SIsC'1'ION 1: I�I:r SCIICDULL Service charges and other Fee Schedule specifications in this Section 1 are to apply for the period(s)of time indicated herein and sh��ll continue in 1'ull force and effect until the earlier of: i) the end of the Fee Schedule Period noted below; ii) the date this Section 1 Fee Schedule is amended or replaced in its entirety: and iii) the date the Agreement is terminated. 1.1 I'LC SCtICllUL� I'LRIOD Fee Schedule specifications in lhis Section 1 are for the Fee Schedule Period commencing on,Tanuary 1,2008 and end- ing on end of day, December 31, 2008. 1.2 GMPLOYER GROUP NUMI3�R(S) For the Fee Schedule Period noted above, the Agreement shall apply to the following Employer Group Number(s): I'22346, P22347, P22348, I'22349 and 022346. 1.3 ADMINISI'IZATIV�CIIAI2G�S ANll CRTDI'1'S a. The Administrative Charge, calculatecl monthly,shall be as specified in the Benefit Program Application of all Net Claim Payments. b. �I'he Cluim Administrator's Network Access Charge, calculated monthly, shall be as specified int�the I3enefit Yrogram Application of all Average Discount Percentage ("ADP") savings. � c. The Termination Administr�tive Ch�r�;e applicable to the Run—Off Period shall be: i. For sen�ice chm�ges(ine[uding, bed itot linaited to, access chm•ges) billetl on a per Conered E►nployee basis ul the tinze of terinination, the Tennination Administrative Charge will be the amount cqual to fiftecn (15°l0) of the annualized charges based on the service charges in effect as of the termination date and the Plan participa- tion of the two (2) months immediately preceding the termination date. , ii. Foi�service cha�ges (including, but�tot limited to,access charges) billed on a basis other thart per Covered Employee at tlze tinte of termi�zation, the Termination Administrative Charge will be such service charges in effect at the time of termination to be applied 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(l0�l0)or more from the enrollment used to determine the service charges in efFect at the time of ter- mination, the Claim Administrator reserves the right to adjust the rates for service charges(induding,but not limited ' to, access charges) to be used to compute the Termination Administrative Charge. ' l.d RrPORTS II "I'he Claim Administrator will make available to the Employer Standard Reports and other Reporting Services as set fbrth in Exhibit 1 —CLAIM ADMINISTRATOR SERVICES of the Agreement in accordance with ils standard reporting po]icy at no additional charge. Any additional reports required by the Gmployer must be mutually agreed upon by the parties in writing prior to their developmenl and may be subjecl to a Supplemental Charge. l.5 CIIAR(�rS I'OR AllDI'1'IONAL SGRVICES '1'he following Additional Services shall be t�urnished: Reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25%, of any recovered amounls* *"1'he indicu(ed Rei�nheu:semenl fee is ha.sed on the net recoi�ery cr�(er nllor•ney's Jees, if uny, hnvc beeit perid. 131ueCard Program/Networh access tees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . available upon reques� I IC'SC II,�\Sn Rev G/07 , -1�-