R2016-136 BlueCross BlueShield Administration of Group Health Benefit Plan 2017

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TABLE OF CONTENTS ADMINISTRATIVE SERVICES AGREEMENT................................................................................................................ 1 SECTION 1: DEFINITIONS, EXHIBITS AND ADDENDA...............................................................................................3 SECTION 2: APPOINTMENT AND SERVICES..............................................................................................................3 SECTION 3: RESPONSIBILITIES OF EMPLOYER AND CLAIM ADMINISTRATOR....................................................3 SECTION 4: THIRD PARTY DATA RELEASE...............................................................................................................5 SSECTION5: CLAIMS/INQUIRIES...................................................................................................................................6 SECTION 6: INDEMNIFICATION....................................................................................................................................7 ECTION 7: AUDIT RIGHTS..........................................................................................................................................7 SECTION 8: TERM AND TERMINATION OF AGREEMENT.........................................................................................8 SECTION 9: RELATIONSHIP OF PARTIES...................................................................................................................8 SECTION 10: NON ERISA GOVERNMENT REGULATIONS........................................................................................9 SECTION 11: PROPRIETARY MATERIALS..................................................................................................................9 SECTION 12: ELECTRONIC DOCUMENTS................................................................................................................ 10 SECTION13: RECORDS.............................................................................................................................................. 10 SECTION 14: APPLICABLE LAW................................................................................................................................. 10 SECTION 15: ENTIRE AGREEMENT...........................................................................................................................11 SECTION 16: NOTICE AND SATISFACTION.............................................................................................................. 11 SECTION 17: LIMITATIONS; LIMITATION OF LIABILITY........................................................................................... 11 SECTION 18: DISPUTE RESOLUTION/ARBITRATION.............................................................................................. 11 SECTION19: NOTICES................................................................................................................................................ 12 SECTION 20: SEVERABILITY; ENFORCEMENT; FORCE MAJEURE.......................................................................12 SECTION 21: INDUSTRY IMPROVEMENT, RESEARCH AND SAFETY...................................................................12 ........ SECTION 22: THIRD PARTY RECOVERY VENDORS AND OUTSIDE ATTORNEYS ...................................... 13 SECTION 23: NOTICE OF ANNUAL MEETING........................................................................................................... 13 SECTION24: DEFINITIONS......................................................................................................................................... 13 EXHIBIT 1 CLAIM ADMINISTRATOR SERVICES ............................ . . .. . . EXHIBIT 2 FEE SCHEDULE, FINANCIAL RESPONSIBILITIES& REQUIRED DISCLOSURES...............................25 SECTION1: FEE SCHEDULE......................................................................................................................................25 SECTION 2: EXHIBIT DEFINITIONS............................................................................................................................25 SECTION 3: COMPENSATION TO CLAIM ADMINISTRATOR...................................................................................26 SECTION 4: CLAIM PAYMENTS26 ........................................... SSECTION 5: EMPLOYER PAYMENT...........................................................................................................................27 ECTION 6: CLAIM SETTLEMENTS ...........................................................................................................................27 SECTION 7: LATE PAYMENTS AND REMEDIES.................................. .. . ..................................................................28 SECTION 8: FINANCIAL OBLIGATIONS UPON AGREEMENT TERMINATION........................................................28 SECTION 9: REQUIRED DISCLOSURE PROVISIONS...............................................................................................29 SECTION 10: PAYMENT OF CLAIMS AND ASSIGNMENT OF BENEFITS...............................................................29 SECTION 11: COVERED PERSON/PROVIDER RELATIONSHIP..............................................................................30 SECTION 12: LIMITED BENEFITS FOR NON—NETWORK PROVIDERS..................................................................30 SECTION 13: CLAIM ADMINISTRATOR'S SEPARATE FINANCIAL ARRANGEMENTS WITH PROVIDERS..........31 SECTION 14: CLAIM ADMINISTRATOR'S SEPARATE FINANCIAL ARRANGEMENTS WITH PRESCRIPTION DRUGPROVIDERS.......................................................................................................................................................31 SECTION 15: CLAIM ADMINISTRATOR'S SEPARATE FINANCIAL ARRANGEMENTS WITH PHARMACY BENEFITMANAGERS...................................................................................................................................................32 SECTION 16: INTER-PLAN ARRANGEMENTS...........................................................................................................33 SECTION 17: MEDICARE SECONDARY PAYER INFORMATION REPORTING ......................................................39 SECTION 18: REIMBURSEMENT PROVISION...........................................................................................................40 SECTION 19: MEMBER DATA SHARING....................................................................................................................40 EXHIBIT 3 RECOVERY LITIGATION AUTHORIZATION.............................................................................................41 EXHIBIT 4 ASO BENEFIT PROGRAM APPLICATION ("ASO BPA")........................................................................43 HCSC IL Gen ASA Med Non ERISA REG Rev.8.16 2 Proprietary and Confidential Information of Claim Administrator Not for use or disclosure outside Claim Administrator,Employer,their respective affiliated companies and third party representatives,except with written permission of Claim Administrator.