R2000-207 AUTHORIZING APPLICATIONS

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charges specified in this Agreement reflect the amount of additional consideration expected to be received by the Claim Administrator in the form of such payments, discounts or allowances. Nei- ther the Employer nor Covered Persons hereunder are entitled 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 except as such items may be indirectly or directly reflected in the service charges spe- cified in this Agreement. A. Services Rendered Out Of Claim Administrator's Service Area From time to time,Covered Persons may receive health care services outside Illinois and from a Provider which does not have a contract with the Claim Administrator fQr the provision of, and payment for, such health care services. Under such circumstances, the Blue Cross and Blue Shield Plan in the particular state in which the services are received (the"Host Plan")will process the Covered Person's Claim in accordance with the Host Plan's applicable contract, if any, with the particular Provider ("Host Plan Provide�'�. The Claim Administrator hereby informs the Employer and all Covered Persons that certain Host Plans may have contracts with Host Plan Providers under which in certain circumstances described therein, the Host Plan may receive substantial payment from Host Plan Providers with respect to services rendered to Covered Persons for which the Host Plan was obligated to pay the Host Plan Provider, or the Host Plan may pay Host Plan Providers less than their billed charges for services, by discounts or otherwise, or may receive from Host Plan Provid- ers other allowances underthe Host Plan's contracts with them.The Employer acknowledges that in negotiating the premiums and/or service charges set forth in this Agreement, it has taken into account that, among other things, the Host Plan may receive such payments, dis- counts and/or other allowances during the term of this agreement with the Claim Administra- tor. Coinsurance amounts, deductibles, out-of-pocket maximums and/or any benefit maximums under this Agreement will be calculated on the basis of the Host Plan Provider's Eligible Charge for Covered Services rendered to a Covered Person or the agreed upon cost for Cov- ered Services that the Host Plan passes to the Claim Administrator, whichever is lower. Often,the agreed upon cost is a simple discount. Sometimes, however,the agreed upon cost may represent either an estimated discount or an average discount realized or expected by the Host Plan based on separate financial arrangements or other non-claims transactions with Host Plan Providers. The estimated or average discount may be adjusted in the future to correct for over or under- estimation of the past determinations of the agreed upon cost. In other instances, laws in a small number of states dictate the basis upon which the Covered Person's liability is calculated. When Covered Services are rendered in one of those states, the coinsurance amount, deductible, out-of-pocket maximum and/or any benefit maximum will be calculated using the state's statutory method. However, the Employer acknowledges that the Claim Administrator may be required to reim- burse the Host Plan only for Claim Payments which have been discounted pursuant to an agreement between the Host Plan and its Host Plan Provider including the service charges thereon. In any event,the Employer shall reimburse the Claim Administrator the amount paid by the Claim Administrator to the Host Plan for Claim Payments plus any service charges pay- able by the Claim Administrator to the Host Plan, in addition to all applicable service charges - � of the Agreement hereunder. B. BlueCard Access Fees From time to time Covered Persons may receive health care services outside Illinois and from a Provider which does not have a contract with the Claim Administrator for the provision of, - 11 -