B. Claims Runout Administrative Services Fees
Claims Runout Administrative Services Fees will be included in the Administrative Services Fee in Section
3(a) of this Schedule A.
Section 7. Other Amendments. The Administrative Services Agreement is otherwise amended as
follows:
BlueCard Program, Other Inter-Plan Programs and Non-Network Provider Fees
As described in Article 15, certain fees and compensation may be charged each time a Claim is processed
through the BlueCard Program, other Inter-Plan Programs, including Negotiated National Account
Arrangements, and non-participating Provider Claims. The extent to which they are (i) included in the
Administrative Services Fee; or (ii) included in Paid Claims or separately billed to Employer is as follows:
Included in Administrative Services Fee:
BlueCard Program toll-free number fee
BlueCard Program PPO health care provider directory fee
Administrative expense allowance fee ("AEA")
Negotiated National Account Arrangement administrative and/or network access fee. It may be based on
either a per Claim, per Subscriber per month or per Member per month basis.
Central Financial Agency fee
ITS transaction fee
Non-Network Provider fees, which include, but are not limited to administrative expense allowance fees,
Central Financial Agency Fees, and ITS Transaction Fees.
Included in Paid Claims or separately billed to Employer:
Access fee, which is a percentage of the discount/differential Anthem receives from the Host Blue, based on
the current rate in accordance with the BlueCard Program's standard procedures for establishing the access
fee rate. The access fee will not exceed $2,000 for any Claim.
Notice of Loss of Grandfathering Status
In the event Employer maintains a grandfathered health plan(s), as that term is used in the Patient
Protection and Affordable Care Act ("PPACA"), Employer shall not make any changes to such plan(s),
including, but not limited to, changes with respect to Employer contribution levels, without providing Anthem
with advance written notice of the intent to change such plan(s). Making changes to grandfathered plans
without notice to Anthem may result in the plan(s) losing grandfathered status and significant penalties
and/or fines to Employer and Anthem. In the event Employer implements changes to its plan(s) and does
not provide advance notice to Anthem, Employer agrees to indemnify Anthem according to the
indemnification provisions set forth elsewhere in this Agreement for any penalties, fines or other costs
assessed against Anthem.
Enterprise Administrative Services Agreement — October 2012 Master Template 24
City of Nashua 06/17/2013
