SCHEDULE B
TO
ADMINISTRATIVE SERVICES AGREEMENT
WITH
CITY OF NASHUA
This Schedule B shall govern the Agreement Period from July 1, 2013 through June 30, 2014. For purposes of this
Agreement Period, this Schedule B 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 B, the
terms of this Schedule B shall control.
SERVICES INCLUDED IN THE ADMINISTRATION FEE IN SECTION 3A OF SCHEDULE A
Management Services
+ Anthem standard Benefits and administration, unless otherwise noted below:
- Anthem definitions and exclusions
- Anthem complaint and appeals process
- Claims incurred and paid as provided in Schedule A
- Accumulation toward plan maximums beginning at zero on effective date
- Anthem Claim forms
- Standard ID card
- Standard Explanation of Benefits
» Acceptance of electronic submission of eligibility information in HIPAA-compliant format
* Preparation of Benefits Booklet (accessible via internet)
* Information for ERISA 5500
* Account reporting - standard data reports
*Billing and Banking Services
- 15/16 day rule on new hire admin fees
* Plan Design consultation
* Employer eServices
- Add and delete Members
- Download administrative forms
- View Member Benefits and request ID cards
- View eligibility
- View Claim status and detail
Claims and Customer Services
* Claims processing services
* Coordination of Benefits
* Recovery Services
* Medicare crossover processing
* Complaint and appeals processing
- One mandatory level of appeal, one voluntary level of appeal
» Employer customer service, standard business hours
Enterprise Administrative Services Agreement — October 2012 Master Template 26
City of Nashua 06/17/2013
