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. , ' 1`�. Tra�sler Payrneni Agre�em�r�i Sperifcations(�oni'tl): I <br /> (b) Payment Period I <br /> ❑ Daily <br /> ❑ Semi-weekly <br /> C� Weekly <br /> ❑ Other: <br /> (c)Claim Settlement Period • <br /> C� Monthly <br /> ❑ Quarterly <br /> ❑ <br /> (d)Term of Agreement: �l one year ❑ years . <br /> (e) Number of Transfer Payments required after termination of agreement: 6 �� <br /> (fl Final Settlement to be made 6 month(s)after termination of agreement. <br /> SERVICES INCLUDED IN THE ASO ARRANGEMENT: � <br /> � Medical Services Advisory Program("MSA") <br /> Effective Date 11/O1/89 � <br /> � Health Benefits Continuation Plan'(HCSC COBRA administrative service) <br /> Effective Date <br /> ❑ Individual Benefits Management Program , <br /> (if MSA is purchased this service is included in the MSA program and this section need not be completed) <br /> Effective Date � <br />- Administrative fee:$ per hour plus expenses computed on an individual case basis. <br /> ADDITIONAL PROVISIONS: Human organ transplant coverage to be included on <br /> Section 0200 at a cost of $.41 per month per single subscriber and $1.50 <br /> per month per family subscriber. <br /> , <br /> Steve Myrvold � <br /> Sales Representative Sign e of Authorized Repr Employer <br /> 848 217-753-5080 City Manag�r � <br /> Dis�rict Phone Number Title <br /> 10/31/89 <br /> Brokerage Representative Date <br /> / <br /> �j1 L[�t-' L ��L�z 2�\ <br /> Brokerage Fum W�tness ! <br /> �;,4-�p�q NrS�Ro•,� =,I.,n Fa.:�?�.�q <br />