2. Perform case management to identify short and long term treatment programs in cases of severe
or chronic illness or injury. Anthem may, but is not required to, customize benefits in limited
circumstances by approving otherwise non-Covered Services if, in the discretion of Anthem, such
exception is in the best interest of the Member and the Plan.
3. Provide access to a specialty network of Providers if the Plan includes a specialty network.
Anthem reserves the right to establish specialty networks for certain specialty or referral care.
4. Provide any other managed care services incident to or necessary for the performance of the
services set forth in this Article 2.
If applicable to the Plan benefits and as indicated in Schedule B of this Agreement, Anthem shall offer
wellness programs and other programs to help Employer effectively manage the cost of care, and Employer
shall pay fees for the programs selected by Employer only if such fees are indicated in Section 3(B) of
Schedule A. Employer shall abide by all applicable policies and procedures of the programs selected, which
may require Employer to provide requested information prior to Anthem initiating the service.
On behalf of Employer, Anthem shall produce and maintain a master copy of the Benefits Booklet and
make changes and amendments to the master copy of the Benefits Booklet and incorporate any approved
changes or amendments pursuant to Article 18(a) of this Agreement. Employer shal! determine, in its sole
discretion, whether Anthem has accurately produced the Benefits Booklet and has fully implemented the
approved changes or amendments. Until Employer has approved the Benefits Booklet, Anthem will
administer the quoted benefits according to Anthem's most similar standard Benefits Booklet language.
Anthem will provide Employer with Plan data and assistance necessary for preparation of the Plan's
information returns and forms required by ERISA or other federal or state laws. Anthem shall prepare and
mail all IRS Form 1099's and any other similar form that is given to Providers or brokers. Form 5500s are
the sole responsibility of Employer; however, Anthem shall provide timely information and, if requested,
assistance. Anthem will disclose its fee and compensation information to Employer, as required by
applicable law, for Employer to complete its Form 5500 and assess its compliance with section 408(b)(2) of
ERISA and any applicable regulations promulgated there under. Employer is solely responsible for the
preparing the summary annual reports.
Anthem shall administer unclaimed funds pursuant to unclaimed property or escheat laws and shall make
any required payment and file any required reports under such laws.
Unless otherwise agreed to by the Parties and specified in the Benefits Booklet, Anthem's standard policies
and procedures, as they may be amended from time-to-time, will be used in the provision of services
specified in this Agreement. In the event of any conflict between this Agreement and any of Anthem's
policies and procedures, this Agreement will govern.
If applicable to the Plan benefits as indicated in Schedule B, Anthem shail provide conversion rights to
Members following termination of this Agreement, and Employer shail pay the fee indicated in Section 3(C)
of Schedule A.
Select state laws require Employers to finance health related initiatives through residency-based
assessments and/or surcharges added to certain Paid Claims. After Employer completes the applicable
forms, Anthem shall make all assessment and/or surcharge payments on behalf of Employer to the
appropriate pools administered by the respective states, based primarily upon Anthem's Paid Claims
information and Member information provided to Anthem by Employer. Examples of such assessments and
surcharges include, but are not limited to, the Massachusetts Health Safety Net Trust Fund, the New York
Health Care Reform Act and the Michigan Health Insurance Claims Assessment Act.
Anthem shail provide required notices describing Member's rights under the Women's Health and Cancer
Rights Act (WHCRA) upon a Member's enrollment and at least annually thereafter.
Anthem shall have the authority to build and maintain its Provider network. Nothing in this Agreement shall
be interpreted to require Anthem to maintain negotiated fees or reimbursement arrangements or other
relationships with certain Providers or Vendors. Anthem will be solely responsible for acting as a liaison
with Providers including, but not limited to, responding to Provider inquiries, negotiating rates with Providers
or auditing Providers.
Enterprise Administrative Services Agreement — October 2012 Master Template 5
City of Nashua 06/17/2013
