ADMINISTRATIVE SERVICES AGREEMENT
This Administrative Services Agreement ("Agreement") is entered into by and between City of Nashua ("Employer")
and Anthem Health Plans of New Hampshire, Inc. dba Anthem Blue Cross and Blue Shield ("Anthem") and is
effective as of July 1, 2013 upon the following terms and conditions:
1. Employer is the sponsor of a self-funded Group Health Plan (as defined below) providing, among other
things, health care benefits to certain eligible employees and their qualified dependents.
2. Employer desires to retain Anthem as an independent contractor to administer certain elements of
Employer's Group Health Plan.
3. Anthem desires to administer certain elements of Employer's Group Health Plan pursuant to the terms of
this Agreement.
In consideration of the promises and the mutual covenants contained in this Agreement, Anthem and Employer (the
“Party" or "Parties" as appropriate) agree as follows:
ARTICLE 1 - DEFINITIONS
For purposes of this Agreement and any amendments, attachments or schedules to this Agreement, the following
words and terms have the following meanings unless the context or use clearly indicates another meaning or intent:
ADMINISTRATIVE SERVICES FEE. The amount payable to Anthem in consideration of its administrative services
and operating expenses as indicated in Section 3 of Schedule A, excluding any cost for stop loss insurance coverage
or any other policy of insurance, if applicable. All additional charges not included in the Administrative Services Fee
are specified elsewhere in this Agreement.
AGREEMENT PERIOD. The period of time indicated in Section 1 of Schedule A.
ANTHEM AFFILIATE. An entity controlling, under common control with or controlled by Anthem.
BENEFITS BOOKLET. A description of the portion of the health care benefits provided under the Plan that is
administered by Anthem.
BILLED CHARGES. The amount that appears on a Member's Claim form (or other written notification acceptable to
Anthem that Covered Services have been provided) as the Provider's charge for the services rendered to a Member,
without any adjustment or reduction and irrespective of any applicable reimbursement arrangement with the Provider.
BLUE CROSS BLUE SHIELD ASSOCIATION ("BCBSA"). An association of independent Blue Cross and Blue
Shield companies.
CLAIM. Written or electronic notice of a request for reimbursement of any health care service or supply on a form
acceptable to Anthem.
CLAIMS RUNOUT SERVICES. Processing and payment of Claims that are incurred but unreported and/or unpaid
as of the date this Agreement terminates.
COVERED SERVICE. Any health care service or supply rendered to Members for which benefits are eligible for
reimbursement pursuant to the terms of the applicable Benefits Booklet.
EMPLOYER AFFILIATES. Companies affiliated with Employer that are participating in the Plan and which, along
with the Employer constitute a single "control group" as that term is used in Internal Revenue Code.
ERISA. The Employee Retirement Income Security Act of 1974, as amended, and regulations promulgated
thereunder.
GROUP HEALTH PLAN OR PLAN. An employee welfare benefit plan (as defined in Section 3(1) of ERISA)
established by the Employer, in effect as of the Effective Date, as described in the Plan Documents, as they may be
amended from time to time.
Enterprise Administrative Services Agreement — October 2012 Master Template 1
City of Nashua 06/17/2013
