t. If a catastrophic event (whether weather-related, caused by a natural disaster, or caused by war, terrorism,
or similar event) occurs that affects Members in one or more locations, and such catastrophic event
prevents or interferes with Anthem's ability to conduct its normal business with respect to such Members or
prevents or interferes with Members’ ability to access their benefits, Anthem shall have the right, without
first seeking consent from Employer, to take reasonable and necessary steps to process Claims and
provide managed care services in a manner that may be inconsistent with the Benefits Booklet in order to
minimize the effect such catastrophic event has on Members. As soon as practicable after a catastrophic
event, Anthem shall report its actions to Employer. Employer shall reimburse Anthem for amounts paid in
good faith under the circumstances and such amounts shall constitute Paid Claims, even if the charges
incurred were not for services otherwise covered under the Benefits Booklet.
u. Anthem shall submit any claim that is required to be filed under any stop loss policy issued by Anthem or an
Anthem Affiliate. Anthem shall have no obligation to prepare or file any claim for excess risk or stop loss
coverage under a policy not issued by Anthem or an Anthem Affiliate. Anthem shall provide Employer with
Claims data pursuant to Article 11 of this Agreement if Employer chooses to file a claim under a stop loss
policy issued by an entity other than Anthem or an Anthem Affiliate. Anthem shall assume no liability or
responsibility to Employer for inconsistencies between the determination of Covered Services under the
Benefits Booklet and this Agreement and the determination of coverage by an unaffiliated stop loss carrier.
Vv. If applicable to Plan benefits as indicated on Schedule B to this Agreement, Anthem shall assist Employer
in determining whether its Prescription Drug benefit constitutes "creditable prescription drug coverage” as
that term is used under the Medicare Part D laws (specifically, 42 C.F.R. 423.56). Unless otherwise agreed
to by the Parties, Employer shall be solely responsible for communicating with Members regarding
creditable prescription drug coverage matters.
W. If a Member is a Massachusetts resident, Anthem shall mail the Member any notices required by the
Massachusetts Health Care Reform Act ("HCRA") reflecting coverage during the current and prior
Agreement Period. If a Member works in Massachusetts for Employer, but resides in another State,
Anthem will only provide such notices if Employer notifies Anthem at least 60 days prior to any notice
deadline imposed by HCRA that such Member requires the HCRA notices.
x. Anthem is the responsible reporting entity (’RRE") for the Plan as that term is defined pursuant to Section
111 of the Medicare, Medicaid and SCHIP Extension Act of 2007. In order to fulfill its RRE obligation,
Anthem requires information from the Employer, including, but not limited to, Member Social Security
Numbers. Employer shall cooperate with Anthem and timely respond to any request for information made
by Anthem.
y. Anthem will provide Employer with Plan information and assistance necessary for the preparation of the
Plan's Summary of Benefits and Coverage ("SBC") related to the elements of the Plan that Anthem
administers. Employer is solely responsible for ensuring that the SBC accurately reflects the benefits
Employer will offer and for finalizing and distributing the SBC to Subscribers. Notwithstanding the
provisions in Article 18(a), if Employer's open enrollment period is at a time other than 30 days prior to the
end of an Agreement Period, Employer agrees to provide Anthem with any changes to the benefits Anthem
administers at least 60 days prior to the start of the open enrollment period.
ARTICLE 3 - OBLIGATIONS OF EMPLOYER
a. Employer shall furnish to Anthem initial eligibility information regarding Members. Employer is responsible
for determining eligibility of individuals and advising Anthem in a timely manner, through a method agreed
upon by the Parties, as to which employees, dependents, and other individuals are to be enrolled Members.
Anthem reserves the right to limit the effective date of retroactive enrollment to a date not earlier than 60
days prior to the date notice is received. Such retroactive enrollments shall be subject to Anthem’'s receipt
of any applicable Administrative Services Fees as indicated in Section 3(A) of Schedule A. Employer shall
keep such records and furnish to Anthem such notification and other information as may be required by
Anthem for the purpose of enrolling Members, processing terminations, effecting COBRA coverage
elections, effecting changes in single or family coverage status, effecting changes due to a Member
becoming eligible or ineligible for Medicare, effecting changes due to a leave of absence, or for any other
purpose reasonably related to the administration of eligibility under this Agreement. Employer
acknowledges that prompt and complete furnishing of the required eligibility information is essential to the
timely, accurate, and efficient processing of Claims.
Enterprise Administrative Services Agreement —- October 2012 Master Template 6
City of Nashua 06/17/2013
