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

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� . � .- , This Agreement made as of January 1, 2008 by and between Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation,a Mutual Legal Reserve Company(hereinafter referred to as the"Claim Administrator"),and City ' of Decatur (hereinafter referred to as the "Employer"), for the Employer Group Number(s) set forth in the Fee Schedule of Exhibit 2 attached hereto,WITNESSETH AS FOLLOWS: RECITALS WHEREAS, the Employer on behalf of the Group Health Plan has executed a Benefit Program Application and the Claim Administrator hereby accepts such Benefit Program Application attached hereto as Exhibit 4; and WHEREAS, the Employer's Group Health Plan has established and adopted an employee welfare benefit plan ("Plan") as described in its plan document,which shall be provided by the Employer to the Claim Administrator; and WHEREAS, the Employer on behalf of the Group Health Plan desires to retain the Claim Administrator to provide certain administrative services with respect to the Plan;and WHEREAS,it is desirable to set forth more fully the obligations,duties,rights and liabilities of the Claim Administrator and the Employer,as representative of the Group Health Plan,with respect to the Plan; NOW, THEREFORE, in consideration of these premises and the mutual promises and agreements hereinafter set forth, the parties hereby agree as follows: SECTION 1: APPOINTMENT The Employer hereby retains and appoints the Claim Administrator to provide services as hereinafter described in connection with the administration of the Plan. SECTION 2:AGREEMENT DEFINITIONS I', 2.1 "Administrative Charge" means the monthly service charge that is required by the Claim Administrator for the II administrative services performed under this Agreement. The Administrative Charge(s)is indicated in the most current Fee I Schedule specifications of Exhibit 2 of this Agreement. � 2.2 "Average Discount Percentage("ADP")"means a percentage discount determined by the Claim Administrator that will be applied to a Provider's Eligible Charge for Covered Services rendered to Covered Persons by hospitals and certain other health care facilities for purposes of calculating Coinsurance amounts, deductibles, out-of-pocket maximums and/or any benefit maximums. The ADP will often vary from Claim to Claim. The ADP applicable to a particular Claim for Covered Services is the ADP,current on the date the Covered Service is rendered,that is determined by the Claim Administrator to be relevant to the particular Claim. The ADP reflects the Claim Administrator's reasonable estimate of average payments, discounts and/or other allowances that will result from its contracts with hospitals and other facilities under circumstances similar to those involved in the particular Claim, reduced by an amount, not to exceed fifteen percent (15%) of such estimate, to reflect related costs. (See provisions regarding "CLAIM ADMINISTRATOR'S SEPARATE FINANCIAL ARRANGEMENTS WITH PROVIDERS" in Exhibit 2 of this Agreement.) In determining the ADP applicable to a particular Claim,the Claim Administrator will take into account differences among hospitals and other facilities,the Claim Administrator's contracts with hospitals and other facilities,the nature of the Covered Services involved and other relevant factors. The ADP shall not apply to Eligible Charges when the Covered Person's benefits under the Plan are secondary to Medicare and/or coverage under any other group program. 2.3 "Certificate of Creditable Coverage" means a document which is generated for Covered Persons terminating coverage under the Plan.The certificate is provided to Covered Persons as evidence for credit of health coverage held under the Plan during the term of this Agreement. 2.4 ��Claim"means notification in a form acceptable to the Claim Administrator that service has been rendered or furnished to a Covered Person.This notification must set forth in full the details of such service including,but not limited to,the Covered Person's name, age, sex and identification number,the name and address of the Provider,a specific itemized statement of the service rendered or furnished, the date of service, applicable diagnosis, the Claim Charge, and any other information which the Claim Administrator may request in connection for such service. -5-