R95-141 AUTHORIZING APPLICATIONS FOR GROUP HEALTH INSURANCE COVERAGE

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B1ueCross B1ueShield An Independent Licensee of the � ' Of�1llO1S Blue Cross and Blue Shield Association �� • � � AMENDMENT TO THE ADMINISTRATIVE SERVICES AGREEMENT Employer Group Number: P06856 Effective Date of this Amendment: January 1, 1996 This Amendment to the Administrative Services Agreement between Health Care Service Corporation, a Mutual Legal Reserve Company(hereinafter referred to as the"Claim Administrator")and City of Deca- tur (hereinafter referred to as the "Employer"), WITNESSETH AS FOLLOWS: WHEREAS, the Employer and Claim Administrator have entered into an Administrative Services Agree- ment which was effective November 1, 1994 (hereinafter referred to as the "AgreemenY'); WHEREAS, the principal purpose of the Agreement is to contract for certain administrative services with respect to the Employer's employee welfare benefit plan (hereinafter referred to as the "Plan") WHEREAS,the Employer and Claim Administrator have agreed to amend the Agreement upon the terms and conditions set forth below, NOW, THEREFORE, in consideration of the mutual covenants and agreements hereinafter contained, the Agreement is hereby amended as stated below. � Section IV, paragraph A of the Agreement is amended by adding the following: 3.90% of Claim Payments for Employer Group Number P06856; Except as herein modified and amended, the provisions, conditions and terms of the Agreement shall re- main in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Amendment to the Administrative Ser- vices Agreement as of the date and year first written above. HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY BY• �LC�X%cs�-�LJ By. �.�„1��' 1�. r', �XxY Title: Und riting Offic r Title: ('.,y ;/vjat�„�.�, .. Date: �—/�. 'y,�j Date:_ 3�I�1 / �l( Witness: Witness: �,�.� ` •