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

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comparison studies, or reports for actuarial analyses. For purposes of this paragraph, a"limited data set" has the meaning set forth in HIPAA and "de-identified" means both member de-identification (as defined by HIPAA) and Employer de-identification (unless the work is being done in connection with Employer's Plan). Solely for the Permitted Purposes, Claim Administrator may release,or authorize the release of,a limited data set or de-identified data to a third party data aggregation service or data warehouse and its customers. Such data warehouse and data aggregation service providers may charge their customers a fee for access to such data. Nothing in the paragraph is intended to expand or limit the terms and conditions of the Business Associate Agreement with respect to the permitted use or disclosure of PHI (other than with respect to limited data sets). The foregoing notwithstanding,the Blue Cross and Blue Shield Association and its support vendors are permitted to have internal access to Claim Administrator-assigned Employer Group and Identification number. SECTION 22: THIRD PARTY RECOVERY VENDORS AND OUTSIDE ATTORNEYS To assist in the recovery of payments, Claim Administrator may engage a third party to assist in identification or collection of recovery amounts related to Claim Payments and Net Claim Payments made under the Agreement. In such event, the recovered amounts will be applied according to Claim Administrator's refund recovery policies. Claim Administrator may also engage a third party to assist in the review of healthcare Providers' Claim coding or billing to identify discrepancies prior to Claim Payments. Third parties'fees associated with such assistance and Claim Administrator's fee for its related administrative expenses to support such third party recovery identification and collection will be paid by Employer and are separate from and in addition to the Reimbursement Fees set forth in the ASO BPA. SECTION 23: NOTICE OF ANNUAL MEETING Employer is hereby notified that it is a Member of Health Care Service Corporation(HCSC),a Mutual Legal Reserve Company, and is entitled to vote either in person, by its designated representative, or by proxy at all meetings of Members of said Company. The annual meeting is held at its principal office at 300 East Randolph Street, Chicago, Illinois each year on the last Tuesday in October at 12:30 P.M. For purposes of this Section, the term"Member'means the group, trust, association or other entity with which this Agreement has been entered. It does not include Covered Employees or Covered Persons under the Plan. From time to time, Claim Administrator pays indemnification or advances expenses to a director, officer, employee or agent consistent with Claim Administrator's bylaws then in force and as otherwise required by applicable law. SECTION 24: DEFINITIONS 24.1 "Accountable Care Organization"means a group of healthcare Providers who agree to deliver coordinated care and meet performance benchmarks for quality and affordability in order to manage the total cost of care for their member populations. 24.2 "Administrative Charge" means the monthly service charge that is required by Claim Administrator for the administrative services performed under this Agreement.The Administrative Charge(s) is set forth in the Fee Schedule. 24.3 "Alternative Compensation Arrangement Payments" means additional payments Claim Administrator makes to Network Providers for services for which no formal Claim form may be submitted, including, but not limited to, capitation payments, performance based reimbursement payments, Care Coordination payments, Value-Based Programs, and other alternative funding arrangements as set forth in Claim Administrator's arrangement with the Network Provider. If the actual amount of such Payment is not known at the time Claim Administrator bills Employer under this Agreement, then Claim Administrator may bill Employer in advance for expected Payments to Network Providers (the "Expected Payments"). Such Expected Payments will be calculated for each specific Alternative Compensation Arrangement on a per member per month ("PMPM") basis. The calculation will be HCSC IL Gen ASA Med Non ERISA REG Rev.8.16 13 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.