SCHEDULE A
TO
ADMINISTRATIVE SERVICES AGREEMENT
WITH
CITY OF NASHUA
This Schedule A shall govern the Agreement Period from July 1, 2013 through June 30, 2014. For purposes of this
Agreement Period, this Schedule shall supplement and amend the Agreement between the Parties. If there are any
inconsistencies between the terms of the Agreement including any prior Schedules, and this Schedule A, the terms of
this Schedule A shall control.
Section 1. Effective Date and Renewal Notice
This Agreement Period shall be from 12:01 a.m. July 1, 2013 to the end of the day of June 30, 2014.
Paid Claims shall be processed pursuant to the terms of this Agreement when incurred and paid as follows:
Incurred from July 1, 2009 through June 30, 2014 and
Paid from July 1, 2013 through June 30, 2014.
Anthem shall provide any offer to renew this Agreement at least 90 days prior to the end of an Agreement
Period.
Section 2. Broker or Consultant Base Compensation
Broker or Consultant Fee is $2.42 per Subscriber per month and is included in the Administrative Services
Fees described in Section 3 of this Schedule A. Upon receipt of payment from Employer, Anthem shall
remit payment to the broker or consultant designated by Employer.
Section 3. Fees
A.
Administrative Services Fee
Administrative Services Fee:
Medical Plan #1 (19940)
HMO Composite $46.47 per Subscriber per month
Medical Plan #2 (124312)
HMO Composite $46.47 per Subscriber per month
Medical Plan #3 (19934)
POS Composite $46.47 per Subscriber per month
Medical Plan #4 (21442)
POS Composite $46.47 per Subscriber per month
Medical Plan #5 (22821)
HSA Composite $46.47 per Subscriber per month
Prescription Drug Rebates: Anthem will pay to Employer 100% of the Drug Rebates collected from PBM
and attributable to Employer's Plan subject to Anthem's timely receipt of payment and accompanying data
from PBM. On a quarterly basis, Anthem shall credit Employer the Drug Rebates it has collected from PBM.
Anthem shall have the right to collect from Employer any rebate amount that Anthem is required to pay
PBM as a result of a pharmaceutical manufacturer audit or for any other reason. Anthem shall continue to
provide Employer its share of the Drug Rebates under this provision until the termination of this Agreement
and any applicable Claims Runout period. Anthem shall provide a final report of the Drug Rebates received
attributable to Employer's Plan after the end of any applicable Claims Runout period.
Enterprise Administrative Services Agreement — October 2012 Master Template 22
City of Nashua 06/17/2013
