Search

Performance
Category
First Call
Resolution

Amount at
Risk

Year 1:
$20,000.00

Guarantee

A minimum of 85% of member calls will be
resolved during the initial contact with no
further follow up required. First Call
Resolution is defined as member callers
receiving a response to their inquiry during
an initial contact with no further foilow-up
required. This Guarantee will be
calculated based on the total number of
members who receive a First Call
Resolution divided by the total number of
calls received into the customer service
telephone system. [This will be measured
with employer specific data.]

Penalty Calculation
Tiering

Result

85.0% or Greater -

83.0% to 84.9%

81.5% to 82.9%

80.0% to 81.4%
Less than 80.0%

Enterprise Administrative Services Agreement — October 2012 Master Template
City of Nashua 06/17/2013

None
25%

“

75%
100%

Measurement
and Reporting
Period .
Measurement
Period

Annual

_ Reporting

Period

Annual

33

Network Drug Pricing Guarantee

Network Drug Pricing Guarantees - Pharmacy Reimbursement Rates

Retail Pharmacy Network Drug Pricing Guarantees and Conditions. The Net Effective Reimbursement Rates for
network retail pharmacies will be subject to the following annual "Retail Network Guarantees":

|. Brand Discount Off AWP: 14.50%
2. Brand Dispensing Fee: $1.40

3. Generic Discount Off AWP: 70.0%
4. Generic Dispensing Fee: $1.40

The Retail Pharmacy Network Guarantees shall be subject to the following conditions:

(1) The following Claims are excluded from the Retail Network Guarantees: (i) prescriptions filled in Alaska, Hawaii,
Puerto Rico; (ii) prescriptions filled in any state which imposes some form of "Most Favored Nations? limitations on
pharmacy reimbursement; (iii) OTC Products, supplies, vaccines, member-submitted Claims, subrogation Claims and
in-house Or 340b pharmacy.

(2) Single Source Generics shall be included in the Brand Discount and Brand Dispensing Fee guarantees rather
than the Generic Discount and Generic Dispensing Fee guarantees.

(3) The Retail Network Guarantees shall be calculated on an aggregate basis, not a per Claim basis..

(4) For purposes of calculating the Retail Network Guarantee payment, if any, deficits in any of the four Retail
Network Guarantees shall be aggregated and reduced by surpluses in any of the Retail Network Guarantees, or any
surpluses in any Mail Service Network Guarantee.

Mail Service Pharmacy Network Drug Pricing Guarantees and Conditions. The Net Effective Reimbursement Rates
for mail service pharmacy will be subject to the following annual "Mail Service Network Guarantees":

1. Brand Discount Off AWP: 24.0%
2. Brand Dispensing Fee: $0.00

3 Generic Discount Off AWP: 75.0%
4. Generic Dispensing Fee: $0.00

* Single Source Generics shall be included in the Brand Discount and Brand Dispensing Fee guarantees rather than
the Generic Discount and Generic Dispensing Fee guarantees.

* The mail service pharmacy network guarantees above are for a 60 day supply or greater. Mail service pharmacy
Claims for less than a 60 day supply are subject to the following guarantees:

1. Brand Discount Off AWP: 24.0%
2. Brand Dispensing Fee: $1.40

3 Generic Discount Off AWP: 75.0%
4. Generic Dispensing Fee: $1.40

The Mail Service Network Guarantees shall be subject to the following conditions:
(1) Specialty Drugs are excluded from the Mail Service Network Guarantees.
(2) The Mail Service Network Guarantees shall be calculated on an aggregate basis, not a per Claim basis.

(3) For purposes of calculating the Mail Service Network Guarantee payment, if any, deficits in any of the Mail
Service Network Guarantees shall be aggregated and reduced by surpluses in any of the Mail Service Network
Guarantees or any surpluses in any Retail Network Guarantees.

Settlement of the Retail Network Guarantees and the Mail Service Network Guarantees for an Agreement Period
shall occur within 90 days after the Agreement Period. The Net Effective Reimbursement Rate for retail and mail
service pharmacy Claims subject to the guarantee shall be compared with the Retail Network Guarantee and Mail
Service Network Guarantee amounts. If the total actual guarantee amount exceeds the applicable Net Effective
Reimbursement Rate, Anthem will credit the amount of the excess to Employer within 30 days of the calculation.

Enterprise Administrative Services Agreement — October 2012 Master Template 34
City of Nashua 06/17/2013

Definitions. For purposes of this Schedule C, the following terms have the following meanings:

Average Wholesale Price or AWP shall mean the price of a prescription drug dispensed as established and reported
by MediSpan, First DataBank, or other nationally recognized pricing source selected by PBM in its sole discretion
from time to time. AWP does not represent a true wholesale price, but rather is a fluctuating benchmark provided by
third party pricing sources.

In the event that there are court or government imposed or industry wide or pricing source initiated changes in the
AWP reporting source or source changes in the methodology used for calculating AWP, including, without limitation,
changes in the mark-up factor used in calculating AWP (collectively, the "AVP Changes"), the terms of any financial
relationship between the parties that relate to AWP shall be modified by Anthem such that the value of AWP for the
purpose of such relationship(s) shall have the same economic equivalence in the aggregate to the value used by the
parties prior to the AWP Change. The intent of this provision is to preserve the relative economics of both parties for
such financial relationships based upon AWP to that which existed immediately prior to the AWP Change.

Further, in the event that the AWP pricing benchmark used by PBM hereunder is replaced with another benchmark
calculation, PBM may switch to such new pricing benchmark upon 30 day prior written notice to Employer, and such
notice will identify any new pricing terms, if any, required to maintain economic equivalence in the aggregate under
the new benchmark.

Net Effective Reimbursement Rate shall mean the overall reimbursement rate paid to pharmacy Network Providers.

Single Source Generics shall mean those generic drugs which are provided by two or less Pharmaceutical
Manufacturers or such Generic Drugs that are in the market with supply limitations or competitive restrictions.

Specialty Drugs are high-cost, injected, infused, oral or inhaled medications (including therapeutic biological
products) that are used to treat chronic or complex illnesses or conditions. Specialty drugs may have special
handling, storage and shipping requirements, such as temperature control. Specialty drugs may require nursing
services or special programs to encourage patient compliance.

Brand Name Prescription Drug or Brand Drug shall mean a prescription drug that is not a Generic Drug.

Dispensing Fee shall mean the amount, other than the AWP minus a discount and any applicable incentives
determined by Anthem as compensation to Participating Pharmacies for providing prescription drugs.

Generic Prescription Drug or Generic Drug shall mean a prescription drug, whether identified by its chemical,
proprietary, or non-proprietary name, that is therapeutically equivalent and interchangeable with drugs having an
identical amount of the same active ingredient.

Enterprise Administrative Services Agreement — October 2012 Master Template 35
City of Nashua 06/17/2013

CITY OF NASHUA

Group Name: ¥
Firm ID: 344217 Ant hem
Effective: 07/01/16 agi ea
HleeCross BlveShie!
REFER TO SUMMARY OF BENEFITS ereeney oy os meron areee ate Br
Benefit: ABN260PY Medicat $20 OV, $250/500 Ded 100% Coin $100 ER :
Drug $5/15/35 RETAIL; $5/30/70 MAIL; UNLIMITED:
BNE182PN Medical $20 OV, $250/500 Ded 100% Coin $100 ER
Drug $5/15/35 RETAIL; $5/30/70 MAIL; UNLIMITED
CGHSA16001 Medical $2000 IN & CON 2XAF 100% IN 70/30% CON Coin INN QOP $2060/4000; QON GOP $4n0N/8000
Drug Ded/Coins
Specific NIA Aggregate: NIA Contract Terms: 24/12 (PAID)
Current State * Current
Administration Assessments Counts
ABN260PY
Individual $48.25 $0.02 535
Couple $48.25 $0.05 2
Parent/Child $48.25 $0.05 144
Family $48.25 $0.07 671
BNE182PN
Individuat $48.25 $0.02 64
Couple $48.25 $0.05 30
Parent/Child $48.25 $0.05 2
Family $48.25 $0.06 28
CGHSA16001
Individual $48.25 $0.03 53
Couple $48.25 $0.05 36
Parent/Child $48.25 $0.05 19
Family $48.25 $0.07 126
[Annual Totals $1,113,417 $4,112 1923 |
l PEPM $48.25 $0.05 1923
[ PMPM $20.03 $0.02 4832 |
Renewal State * Current
Administration** Assessments Counts
ABN260PY
Individual $49.40 $2.21 535
Couple $49.40 $4.42 342
Parent/Child $49.40 $4.42 414
Family $48.40 $5.97 571
BNE182PN
Individual $49.40 $2.04 64
Couple $48.40 $4.08 30
Parent/Child $49.40 $4.08 2
Family $49.40 $5.91 28
CGHSA16001
Individual $48.40 £2.39 59
Couple $49.40 $4.79 36
Parent/Child $49.40 $4.79 19
Family $49.40 $6.46 126
[Annual Totals $1,140,037 $98,742 1923 |
[ PEPM $49.40 $4.28 i923
PMPM $20.51 $1.78 4632 I
[Percent 24% |

Advance Deposit

$560,953 Group's current balance on 7/1/2616 will be applied to satisfy this deposit.

* Actual Assessments for the Vaccine Program are assessed on child covered lives (<19 yrs residing in NH) and will appear on the monthly medical ASO bill. The rate is currently $9.95 and is subject to change.

* ASO admin fees will be billed on a PEPM basis. Anthem ASO Administration fee assumes Rx Rebate sharing (with CON) at 100%.

¥ CON agrees to a three year contract, Anthem will guarantee that the Anthem Administration fee increase for years 2 and 3 will be limited to a max/year of 2.5%.
*“The benefits reflected in this quotation have been adjusted to comply with changes required by the Affordable Care Act beginning in 2014.

PEPM

Commissions Admin Fee $ 55,843.92 $2.42
StopLoss $ - $0.00

Total Commissions $ 55,843.92 $2.42

estimated membership while final commissions are based on actual membership.

The above commissions may vary from final commissions because they are based on

Anthem does not include any standard commissions in administrative retention paid by group.
This quote carrles commissions requested by the Producer of Record as follows:

LB

| have read and agreed to the terms and conditions as outlined in the ASO Pricing Assumptions.

Total # of eligible employees:

City of Nashua_D Multi 051016.xlsm

Blended Aligned ASO Rate Sheet

05/10/2016

Group Name: CITY OF NASHUA

Firm 1D: 344217 Anthem.)
ective: O701N6 . . ay ee ag ee

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ing Assumption

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The proposed services, rates and fees are effective from July 1, 2016 through July 1, 2617.

This contract will be issued in New Hampshire.

Our quote assumes that 1923 employees will be enrolling for medical coverage, with an average member to employees ratio of 2.41.
Quoted rates are subject to review of audited financial statements and Dun & Bradstreet reports prior to final sale.

Anthem reserves the right to amend these rates due to any taxes, fees and assessments prescribed by any statutory, regulatory, or other
legal authority, which may bear directly on the financial consequences of this quote.

This proposal expires [60] days from the date of release of this proposal or on the effective date whichever is sooner.

The health benefit plan(s) reflected in this quote is not considered to be grandfathered under the provisions of the Patient Protection
and Affordable Care Act. Nongrandfathered plans are subject to additional provisions under the Patient Protection and Affordable Care
Act that do not apply to grandfathered plans. For further information, please contact your account representative.

This renewal rate includes changes to the standard medical plan to ensure compliance with the requirements of the federal health care
reform legislation for nongrandfathered plans, including 100 percent coverage of in-network preventive care services.

Anthem Blue Cross and Blue Shield reserves the right to revise this proposal under any of the following circumstances:

(1) a change to the Plan benefits initiated by Employer that results in a substantial change in the services to be provided by Anthem Blue
Cross and Blue Shield;

(2) a change in ownership

(3) a change in the total number of Subscribers or Members resulting in either an increase or decrease of [10%] or more of the number of
Subscribers or Members enrolled for coverage on the date the Administrative Services Fee was last modified;

(4) a change in Employer contribution

(5) a change in nature of Employer’s business resulting in a change in its designated Standard Industrial Classification (“SIC”) code; or

(6) a change in applicable law that resuits in an increase in the cost or amount of administrative services from those currently being provided
by Anthem Blue Cross and Blue Shield. The cost for our standard reporting package is included in the proposed ASO fee. Non-standard
reports may be subject to an additional fee depending on the complexity and frequency requested.

Electronic eligibility or tape feeds must be in a format compatible with our systems.

Anthem Blue Cross and Blue Shield’s proposal assumes claims incurred prior to the effective date are not included unless specifically noted.

A change in the contract period will require a recalculation of fees.

The cost of our standard reporting package is included in the proposed ASO fee. Non-standard reports may be subject to an additional
fee depending on the complexity and frequency requested.

Proposed rates are payable by the invoice due date.

Section 1341 of the Affordable Care Act (ACA or health care reform law) provides that a transitional reinsurance program be established in
each State to help stabilize premiums for coverage in the individual market during the vears 2014 through 2016. ACA Reinsurance Fees in
2014 are estimated to be $5.25 per participant per month. This quote or renewal does not include the ACA Reinsurance Fees, since it is
assumed that the employer will remit payment to HHS directly,

Federal law requires group health plans to cover services for mental health care or substance abuse at the same levels as your medical
services. Generally speaking, this means visit limits and the amounts you pay (such as copayments and deductibles) must be the same for
covered services that treat body or mind. This is called “mental health parity.”

For renewals on or after July 1, 2014, we reviewed your plan benefits to make sure they comply with the mental health parity laws. Certain
visit limits will no longer apply to autism services. No other changes are needed.

BlueCard Access fees are included in paid claims amount. The BlueCard Access Fee is charged at a percentage no greater than 4.79% of the

discount subject to a maximum of $2,000 per claim. Access fees vary depending on the specific arrangement in local plan areas. Fora
complete description of these fees, please consult your ASO Agreement.

City of Nashua_D Multi 051016.xlsm 05/10/2016 ASO PRICING ASSUMPTIONS 20f2

SUMMARY OF THE 1996 NEW HAMPSHIRE LIFE AND HEALTH
INSURANCE GUARANTY ASSOCIATION ACT (RSA 408-B)
AND
NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS

Residents of New Hampshire who purchase life insurance, health insurance, and annuities should know that the
insurance companies licensed in New Hampshire to write these types of insurance are members of the New
Hampshire Life and Health Insurance Guaranty Association. The purpose of this Association is to assure that
policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable
to meet its policy obligations. If this should happen, the Association will assess its other member insurance
companies for the money to pay the covered claims of policyholders who live in New Hampshire and, in some cases,
to keep coverage in force. This protection is not a substitute for consumers’ care in selecting companies that are
well-managed and financially stable, The valuable extra protection provided by these insurers through the Guaranty
Association is not unlimited, however, as noted below.

IMPORTANT DISCLAIMER

The New Hampshire Life and Health Insurance Guaranty Association may not provide coverage for this policy. If
coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in
New Hampshire. Other conditions may preclude coverage.

Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you
have assumed the risk, such as a variable contract sold by prospectus.

Insurance companies or their agents are required by law to give or send you this notice. However, insurance
companies and their agents are prohibited by law from using the existence of the Association to induce you to
purchase any kind of insurance policy.

This information is provided by:

New Hampshire Life and Health Insurance Guaranty Association
47 Hall Street, Suite 2
Concord, NH 03301
(603) 226-9114

New Hampshire Department of Insurance
21 South Fruit Street, Suite 14
Concord, NH 03301
(603) 271-2261

(please turn to next page)

Form PA-8857-1 New Hampshire Printed in U.S.A.

SUMMARY:

The 1996 state law that provides for this safety-net coverage is called the New Hampshire Life and Health Insurance
Guaranty Association Act. Below is a brief summary of this law's coverage, exclusions and limits, This summary
does not cover all provisions of the law and it does not in any way change one's rights or obligations under the Act or
the rights or obligations of the Association.

COVERAGE:

Generally, individuals will be protected by the New Hampshire Life and Health Insurance Guaranty Association if
they live in this state and hold a life or health insurance policy or an annuity contract, or if they are insured under a
group insurance contract, issued by a member insurer. The beneficiaries, assignees or payees of insured persons are
protected as well, even if they live in another state.

Coverage provided under this Act may be different from coverage provided prior to 1996, as coverage is determined
by the governing Act in effect on the date that the Association becomes obligated.

EXCLUSIONS FROM COVERAGE:
Persons holding such policies or contracts are NOT protected by this Association if:

they are not residents of the state of New Hampshire, except under certain very specific circumstances;
they are eligible for protection under the laws of another state; or

e their policy was issued by a nonprofit hospital or medical service organization, an HMO, a fraternal benefit
society, a mandatory state pooling plan, a mutual assessment company or any entity that operates on an
assessment basis, an insurance exchange, or any entity similar to any of the above.

The Association also does NOT provide coverage for:

® any policy or portion of a policy or contract not guaranteed by the insurer or under which the risk is borne by the
policy holder or contract holder;

e any policy or contract of reinsurance, unless assumption certificates have been issued;

e interest rate guarantees that exceed certain statutory limitations;

e any plan or program of an employer, association, or similar entity to provide life, health, or annuity benefits to its
employees or members to the extent that the plan or program is self-funded or uninsured, including, but not
limited to, benefits payable by an employer, association, or similar entity;
dividends, experience rating credits, or fees for services in connection with an insurance policy;
any policy or contract issued in this state by an insurer at a time when it was not licensed or authorized to do
business in New Hampshire;

e any unallocated annuity contract issued to an employee benefit plan protected under the federal Pension Benefit
Guaranty Corporation;

e any portion of any unallocated annuity contract which is not issued to or in connection with a specific employee,
union, or association of natural persons benefit plan or a government lottery; or

¢ any portion of a policy or contract to the extent that the required assessments are preempted by federal or state
law.

LIMITS ON AMOUNT OF COVERAGE

The Act also limits the amount the Association is obligated to pay. The Association cannot pay more than what the
insurance company would owe under a policy or contract.

With respect to any one life, the Association will pay a maximum of $300,000 - no matter how many policies and

contracts there were with the same company, even if they provided different types of coverages. Within this overall
$300,000 limit, the Association will not pay more than $100,000 in cash surrender values, $100,000 in health

Form PA-8857-1 New Hampshire Printed in U.S.A.

To:

From:

Re:

A. Motion:

Discussion:

City of Nashua, Public Works Division

Board of Public Works Meeting Date: March 24, 2022

Jeff Lafleur, Superintendent
Solid Waste Department

To approve the purchase of Recycling and Trash carts from Toter, Inc.

To approve the purchase of recycling and trash carts and cart lids for curbside
collection for FY22 in an amount not-to-exceed $145,000 from Toter, Inc. of
Statesville, NC. Funding will be through: Department: 168 Solid Waste; Fund:
Solid Waste; Account Classification: 71 Equipment.

Toter Inc. has been the vendor supplying trash and recycling carts for the City of
Nashua since 2003 when the automated trash collection program started. The
curbside recycling program has grown immensely and the demands for recycling
carts are on the rise.

In October 2002 (RFP #0721-110802), a nine member committee comprised of
DPW, BPW, and Purchasing officials as well as a representative of the Board of
Aldermen and the general public interviewed prospective vendors and evaluated
their proposals. Toter Inc. was chosen and has been providing a quality product and
excellent service as well as honoring warranty claims presented.

insurance benefits, $300,000 in long-term care benefits, $100,000 in present value of annuities, or $300,000 in life
insurance death benefits.

With respect to any one contract holder of an unallocated annuity contract, not including a governmental retirement
plan established under Section 401, 403(b) or 457 of the U.S. Internal Revenue Code, the Association will pay a
maximum of $5,000,000 in benefits, irrespective of the number of such contracts held by that contract holder.

ADDITIONAL INFORMATION:

Policyholders should contact the New Hampshire Insurance Department with questions they may have with regard to
concerns about their rights under the Act and procedures for filing a complaint to allege a violation of the Act.

Policyholders may contact the New Hampshire Insurance Department for sources of information about the financial
condition of insurers.

Form PA-8857-1 New Hampshire Printed in U.S.A.

HARVARD PILGRIM HEALTH CARE, INC.

PURCHASER SERVICE AGREEMENT

This Agreement, made effective and entered into this 1° day of July, 2002_(Effective
Date) by and between CITY OF NASHUA (hereinafter referred to as “Purchaser*), and
HARVARD PILGRIM HEALTH CARE, INC., a corporation organized under the laws of the .
Commonwealth of Massachusetts (hereinafter "HPHC"), - -

WHEREAS, Purchaser has adopted one or more self-insured health care plan{s)
(hereafter the "Plan(s)") for eligible employees, retirees, and the dependents thereof under ~
which such persons are enittled to certain health service benefits (hereafter "Covered ,

Services"); ,

WHEREAS, Purchaser desires to purchase certain administrative and provider
contracting services for operation of its Plan from HPHC as set forth below: “4

WHEREAS, HPHC desires to provide such administrative and provider contracting
services for Purchaser’s Plan; and ,

‘ WHEREAS, a copy of the Plan instrument(s) is/are attached hereto as Attachment EL

NOW THEREFORE, in consideration of the promises and mutual covenanis contained
herein the receipt and sufficiency of which are hereby acknowledged, it is hereby agreed by

and between the parties as follows:

|. SERVICES AND COMPENSATION

14 Administrative Services. HPHC shall perform for Purchaser the administrative
services set forth in Attachment A, “Administrative Services" attached hereto and incorporated
herein by reference (hereafter “Services”), for the operation of the Plan. HPHC shall perform
these Services in accordance with the reasonable exercise of its business judgment and all
applicable statutory and regulatory requirements, Purchaser shall at all times retain ultimate
control over the assets and operations of the Plan and final responsibility for the obligations of
the Plan imposed by law. HPHC shall perform the functions described in this Agreement in
accordance with policies, directives, and controlling documents of the Plan.

1.2 Provider Contracting Services. To the extent any Plan provides for use of
contracting providers by Members, then through contractual arrangements (“Provider
Contracting Services"), HPHC shall establish a network of physicians, hospitals and other
health care providers or entities, contracting with such providers for the provision of Covered
Services from health care providers ("Contracting Providers") to Members. A current list of
Contracting Providers will be provided to Purchaser by HPHC from time to time as required,
either in print or electronic media. Purchaser shall compensate Coniracting Providers for
Covered Services in accordance with the Contracting Provider Compensation Provisions
attached hereto as Attachment B, and incorporated herein by reference.

FORM#PSO1 08/17/2002