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

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Y t �- • 1 \.- refunds,and unsolicited refunds. In some cases,the Ilost Blue will engage third parties to assist in discovery or collection of recuvery amotnris.`I'he fees o1'such a third party are netted against the recovery. Recovery amounts, net of fees, if any, will be applied in accordance with applicable BlueCard Policies,which generally require correction on a Claim-by-Claim or prospective basis. 14.4 131ueC:�rd I�ees und Compenst►tion The Lmployer understands and agrees a)to pay certain 1'ees and compensation to the Claim Administrator which the Claim Administrator is obligated under BlueCard ro pay to the I-Iost Blue,to the I31ue Cross and Blue Shield Association,or to lhe BlueCard vendors and b) that fees and compensation under BlueCard may be revised from time to time withoul the l;mployer's prior approval in accordance with the standard procedures for revising fees and compensation under Blue- Card. Some of these {'ees and compensation are charged each time a Claim is processed through BlueCard and inelude, bu� are not limited to,access fees,administrative expense allowance fees,Central Financial Agency Fees,and ITS Trans- action Fees. Also,some of these Claim-based fees,such as the access 1'ee and the administrative expense allowance fee, may be passed on to the Employer as an additional Claim liability. Other fees include, but are not limited to, a toll-free phone number fee and a fee for providing certain Provider directories. If you do no� have a complete listing,or want an updated listing, of these types of'fees or the amount of these fees paid directly by the Employer, you should contact the Claim Administrator's representative. SEC'I'ION l5: SI;RVICING PLAN AGR��M�NTS B�7'W��N CLAIM AllMINIS'I'RAI'012 ANll O'1'H�R I3LU�CROSS AND I3LU�SHI�LD PLANS 15.1 In some instances, the Claim Administrator has entered into agreements with other Blue Cross and Blue Shield Plans (hereinafter called the "Servicing Ylans") to provide,on the Claim Administrator's behalf�, Claim Payments-and certain administrative services for those Covered Persons of the Employer residing in the state and/or service area of the Servic- ing Plans. Pursuant to the agreement between the Claim Administrator and the Servicing Plans,the Claim Administrator has agreed to reimburse each Servicing Plan for all Claim Payments made on the Claim Administrator's behalf for those Covered Persons of the Employer residing in the state and/or service area of such Servicing Plan. 15.2 The Claim Administrator hereby informs the Employer,and the Employer shall advise its Covered Persons,that certain Servicing Plans may have contracts with certain Providers("Servicing Plan Providers")in their service area for the provi- sion o1�,and payment�for,health care services to persons entitled to health care benefits under health policies and contracts to which the Servicing Plan is a party, including the Covered Persons covered under the Administrative Services Agree- ment, and that pursuant to the Servicing Plan's contracts with its Servicing Plan Providers, under certain circums[ances described therein,the Servicing Plan may receive substantial payment from Servicing Plan Providers with respect to ser- vices rendered to such persons for which the Servicing Plan was obligated to pay the Servicing Plan Provider,or the Ser- vicing Plan may pay Servicing Plan Providers less than their billed charges for services, by discounts or otherwise, or may receive from Servicing Plan Providers other allowances under the Servicing Plan's contracts with them.The Employ- er acknowledges lhat in negotiating the service charge set torth in the Agreemenl, i� has taken into consideration that, among other things, Ihe Servicing Plan may receive such payments,discounts and/or other allowances during the term of its agreement with the Claim Administratoc Further,all amounts payable to the Servicing Plan by the Claim Adminis- trator for Claim Payments made by the Servicing Plan and applicable service charges thereon pursuant to the terms of its agreemen� with the Claim Administrator(and with respect to most Servicing Plans,any required deductible and Coin- surance amounts under the �mployer's 1'lan) shall be calculated on the basis of the Servicing Plan Provider's Claim Charge for Covered Services rendered to a Covered Person, irrespective of any separate {'inancial arrangement between the Servicing Plan Provider and the Servicing Plan as referred to herein. Hpwever, the �mployer acknowledges that the Claim Administrator, under its contract with each Servicing Plan, may be required to reimburse the Servicing Plan only for Claim Payments which have been discounted pursuant to an agreement between the particular Servicing Plan and its Servicing Plan Providers including the service charges thereon. In any event the Employer shall reimburse the Claim Administrator the amount paid by the Claim Administraror to the Servicing Plan for Claim Payments plus any service charges payable by the Claim Administrator to the Servicing Plan,in addition to applicable service charges of the Claim Administrator hereunder. 15.3 The Claim Administrator hereby informs the Employer,and lhe Employer acknowledges,that the Claim Administrator's, the f lost Plans' and the Servicing Plans' Nrovider contracting arrangements, operational practices and procedures, and i icsc n.�sn iz��.�/o� -27-