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

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� #, ' . mary Care Physician shall not be based upon the type, amount or cost of services required by the Covered Person or the physical condition of the Cc�vered I'erson excepl where reasonably necessary to provide optimal medical care. 11.4 Inlent of terntinology. The use of an ad.jective such as Approved,Administrator, Yarticipating, In-Network or Network in modif'ying a Provider shall in no way be construed as a recommendation,refierral or any other statement as to the ability or quality of such Provider. In addilion,the omission,non—use or non—designation of Approved,Administrator, Partici- paling, In-Network, Network or any similar modifier or the use of a term such as Non-Approved, Non-AdminisUator, ' Non-Participating, Oul-of-Network or Non-Nelwork should not be construed as carrying any slatement or inference,neg- ', ative or positive, as to the skill or quality of such Provider. 11.5 Pronider's role. �ach Provider provides Covered Services only to Covered Persons and does not deal with or provide any services to the Employer(other than as an individual Covered Person) or the Plan. S�CTION 12: LIM1T�ll I3�N�rI1'S FOI2 NON-N�1'WORK PROVII)�RS The Employer acknowledges that when Covered Persons elect to utilize the services of a non-Network professional Provider for a Covered Service in non-emergency situations,benefit payments to such non-Network professional Provider are not based upon the amount billed. 7'he basis of the benefit payment will be determined according to the Plan's 1'ee schedule, usual and customaiy charge (which is delermined by comparing charges for similar services adjusted to the geographica] area where the services are performed),or other melhod �s defined under the Plan. Non-Network Providers may bill the Plan's Covered Person for any amount up to lhe billed charge after the Claim Administrator has paid the Plan's portion of the bill. Network Providers have agreed to accepl discounted payments fbr services with no additional billing to the Covered Yerson other than Coinsurance and deductible amounts. A Covered Person may obtain further information about the Network status of professional Providers and information on out-of-pocket expenses by calling the toll-free number on their identification card. � S�C'I'ION 13: CLAIM ADMINISI'12ATOR'S S�PARAI'�rINANCIAL AI2RANG�M�N'I'S WI'I'H PROVID�RS 13.1 All amounts payable to the Claim Administrator by the Employer for Claim Payments provided by the Claim Administra- tor and applicable service charges pursuant to the terms of the Agreement and all required deductible and Coinsurance t�mounts under the Agreement shall be calculated on the basis of the Provider's Eligible Charge or Provider's Claim Charge less the ADP,unless otherwise directed in writing by the �mployer,for Covered Services rendered to a Covered Person, irrespective of any separate financial arrangement between any Administrator Provider or the Employer and the Claim Administrator. 13.2 "t'he Employer acknowledges that the Claim Administrator has conhacts with certain Providers("Administrator Provid- ers") for the provision of,and payment for, health care services lo all persons entilled to health care benefits under individ- ual certificates, agreements and contracts to which the Claim Administrator is a party, including the Covered Persons under the Agreement, and that pursuant to the Claim Administrator's contracts with Administrator Yroviders,under cer- tain circumstances described therein,the Gaim Administrator may receive substantial payments from Administrator Pro- viders with respect to services rendered to all such persons for which the Claim Administrator was obligated to pay Ad- ministrator Providers, or the Claim Adminislrator may pay Administrator Providers less than their Claim Charges for services, by discounts or otherwise,or may receive from Administrator Providers other allowances under the Claim Ad- ministrator's contracts with them. The Employer acknowledges that in negotiating the service charges set forth in the Agreement, it has taken into consideration that the Claim Administrator may receive such payments, discounts and/or other allowances during the term of the Agreement and that the service charges specified in ihe Agreement reflect the amount of additional consideration expected to be received by the Claim Administrator in the form of such payments, discounts or allowances. Neither the Employer nor Covered Persons hereunder are entided to receive any portion of any such payments, discounts and/or other allowances in excess of the ADP as part of any Claim Settlement or otherwise excep� as such items may be indirectly or directly reflected in the service d�arges specified in the Agreement. 13.3 "The Claim Administrator's compensation for its services under the Agreemenl shall include the difference between the Net Claim Payments reimbursed to the Claim Administrator by the Employer under the Ageement and the net amounts paid to Providers b��the Claim Administrator after giving efl'ect to the Claim Administrator's Separate Financial Arrange- ments wilh Providers. i icsc��i,nsn ii��- ��io� -25-