4. Any bankruptcy, receivership, insolvency or inability of Employer to pay its debts as they become
due.
i. The Employer shall have the sole responsibility, in accordance with state or federal law, to develop
procedures for determining whether a medical child support order is a "qualified" medical child support
order. The Employer shall provide notice to Anthem once it has made such determination.
j. The Employer may request Anthem, on an exception basis, to process and pay Claims that were denied by
Anthem or take other actions with respect to the Plan that are not specifically set forth in this Agreement or
the Benefits Booklet. In such cases, any payments shall not count toward the stop loss accumulators under
a stop loss agreement issued by Anthem, unless otherwise agreed to by Anthem. Anthem may charge
Employer a processing fee that has been mutually agreed to by the Parties prior to the processing of the
Claim. Anthem shall not be responsible for any liability associated with any act or omission undertaken at
the direction of, or in accordance with, instructions received from the Employer under this provision.
ARTICLE 4 - CLAIMS PAYMENT METHOD
a. Employer shall pay or fund Paid Claims according to the Claims payment method described in Section 4 of
Schedule A. Employer shall pay or fund such amounts by the Invoice Due Date. In addition, from time to
time, the Parties acknowledge that Employer may request a review of the appropriateness of a Claim
payment and, during the review period, Employer shall pay or fund such Claim.
b. The Parties acknowledge that, from time to time, a Claims adjustment may be necessary as a result of
coordination of benefits, subrogation, workers' compensation, other third party recoveries, payment errors
and the like, and that the adjustment will take the form of a debit (for an additional amount paid by Anthem)
or a credit (for an amount refunded to Employer). The Parties agree that such Claims adjustment shall be
treated as an adjustment to the Claims payment made in the billing period in which the adjustment occurs,
rather than as a retroactive adjustment to the Claim in the billing period in which it was initially reported as
paid. Any Claims credit may be reduced by a fee charged by Vendors as indicated in Article 13 of this
Agreement. In addition, a credit shall not be provided to Employer for a recovery related to a Claim that
was covered under stop loss coverage provided by Anthem.
ARTICLE 5 - ADMINISTRATIVE SERVICES FEE
During the term of this Agreement, Employer shall pay Anthem the Administrative Services Fee, described in
Section 3 of Schedule A. Employer shall pay the Administrative Services Fee and other fees authorized under this
Agreement by the applicable Invoice Due Date according to the payment method described in Section 5 of Schedule
A.
ARTICLE 6 - RENEWAL SCHEDULES
If Anthem offers to renew this Agreement at the end of an Agreement Period, then Anthem shall provide Employer
with the terms and conditions of the proposed renewal in writing within the time period provided in Section 1 of
Schedule A. Employer shall notify Anthem in writing of its selection from the renewal options by indicating its
selection and signing Anthem's designated renewal form. If Anthem does not receive a signed acceptance of the
renewal from Employer prior to the start of the next Agreement Period, Employer's payment of the amounts set forth
in the renewal shall constitute Employer's acceptance of the terms. Anthem shall provide a revised Schedule A that
will become part of this Agreement without the necessity of securing Employer's signature.
Enterprise Administrative Services Agreement — October 2012 Master Template 8
City of Nashua 06/17/2013
