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

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a. That the requested documents, records and other information(for purposes of this Section 4,"Confidential Information")are proprietary and confidential in nature and that the release of the Confidential Information may reveal Claim Administrator's Business Confidential Information. b. To maintain the confidentiality of the Confidential Information and any Business Confidential Information (for purposes of this Section 4, collectively, "Information") and to prevent unauthorized use or disclosure by Employer's Vendor(s) or unauthorized third parties, including those of its employees not directly involved in the performance of duties under its contract with Employer, to the same extent that it protects its own confidential information. c. To maintain the Information at a specific location under its control and take reasonable steps to safeguard the Information. d. To use, and require its employees to use, at least the same degree of care to protect the Information as is used with its own proprietary and confidential information. e. To not duplicate the Information furnished in written, pictorial, magnetic and/or other tangible form except as necessary to fulfill the purposes of this Agreement or as required by law. f. To return or destroy the Information at the direction of Claim Administrator or within a reasonable time after the termination of this Agreement, not to exceed 60 days thereafter. 4.2 Third party obligations. Employer's Vendor(s) shall execute Claim Administrator's then-current data exchange agreement as required by Claim Administrator. 4.3 Employer obligations. Employer shall: a. Provide Claim Administrator in writing the names of any Employer's Vendor(s) with whom Claim Administrator is authorized to release, disclose or exchange data. If Employer's Vendor(s) is under contract to perform services that involve the use, access or disclosure of Protected Health Information as defined by HIPAA,the identity of Employer Vendor(s)shall be documented within the Business Associate Agreement between Claim Administrator and Employer. b. Provide Claim Administrator in writing, the appropriate authorization and specific directions with respect to the release, disclosure or exchange of data with Employer's Vendor(s) identified under 4.3.a. If Employer's Vendor(s) perform services that involve the use, access or disclosure of Protected Health Information as defined by HIPAA, the information required in this Section will be documented in the Business Associate Agreement between Claim Administrator and Employer. c. Indemnify, defend (at Claim Administrator's request) and hold harmless Claim Administrator and its employees, officers, directors and agents against any and all losses, liabilities, damages, penalties and expenses, including attorneys' fees and costs, or other cost or obligation resulting from or arising out of claims, lawsuits, demands, settlements or judgments brought against Claim Administrator in connection with any claim based upon Claim Administrator's directed disclosure, including but not limited to disclosure of Protected Health Information, to the designated Employer Vendor(s), if consistent with Employer's directions, of any information and/or documentation or breach by Employer's Vendor(s) of any obligation described in this Agreement. SECTION 5: CLAIMS/INQUIRIES 5.1 Claim Administrator's responsibilities. As provided in this Agreement, Claim Administrator will receive eligibility information, review and process properly filed Claims, respond to Covered Person's inquiries and conduct Claim reviews and appeals; however, Claim Administrator does not have final authority to determine Covered Persons'eligibility or to establish or construe the terms and conditions of the Plan. 5.2 Claim appeals. After exhaustion of all internal claim review remedies offered by Claim Administrator, a Covered Person may appeal all adverse benefit determinations to Employer. Claim Administrator will cooperate in providing Claim information pursuant to Section 3 above. 5.3 Internal Claim Administrator reviews. On occasion Claim Administrator may deny all or part of submitted Claims. Upon request of the Covered Person or the Covered Person's authorized representative, Claim Administrator will provide a review of any adverse determination of a Claim, or any adverse determination of pre-service Claim when the Covered Person would have an adverse financial impact for failing to pre-authorize the service. Certain Claims, pre-service requests for review, or inquiries where there is a question as to HCSC IL Gen ASA Med Non ERISA REG Rev.8.16 6 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.