Cc. In the event of any legal action or proceeding against the Employer or Plan pertaining to Covered Services
described in the Benefits Booklet, Anthem shall make available to Employer, the Plan, and their respective
counsel, such evidence that is not privileged or otherwise confidential and is relevant to such action or
proceeding.
ARTICLE 17 - INDEMNIFICATION
d, Non-Network Providers Outside Anthem's Service Area.
ii. an estimated price. An estimated price is a negotiated payment reduced or increased by a
percentage to take into account certain payments negotiated with the Provider and other
Claim- and non-Claim-related transactions. Such transactions may include, but are not limited
to, anti-fraud and abuse recoveries, Provider refunds not applied on a Claim-specific basis,
retrospective settlements, and performance-related bonuses or incentives, or
PBM has negotiated programs with pharmaceutical manufacturers under which rebates for certain
Prescription Drugs dispensed to Members are made directly to PBM ("Drug Rebate Programs"). Such
Drug Rebate Programs are not based on the drug utilization of any one Employer Plan, but rather are
based on the drug utilization of all individuals enrolled in PBM managed programs. In many cases the
rebates are conditioned on certain Prescription Drugs being included on the formulary that Anthem requires
Cc. Notwithstanding any other provision of this Article 13, Anthem will periodically perform audits of Provider
and Vendor contracts and other Claims audits to determine if Claims were accurately paid. Anthem shall
have authority to enter into a settlement or compromise regarding these audits, including, but not limited to,
the right to reduce future reimbursement to Provider or Vendor in lieu of a lump sum settlement. If Anthem
conducts an audit and makes a recovery as a result of such audit of Claims accuracy, then Anthem shall
b. if Employer elects to utilize a third-party auditor to conduct an audit pursuant to this Agreement and
Anthem's audit policy, such auditor must be mutually acceptable to Employer and Anthem. Anthem will
only approve auditors that are independent and objective and will not approve auditors paid on a
contingency fee or other similar basis. Anthem reserves the right to charge a fee to Employer for
expenditure of time by Anthem's employees in completing any audit. An auditor or consultant must execute
d. Employer may disclose the minimum amount of Anthem's Information necessary to Employer]'s stop loss
carriers, consultants, auditors and Plan Contractors, provided that: (1) each such third party needs to know
such Information in order to provide services to Employer; (2) the restrictions contained in Article 10(c) shall
apply to each such third party as well as to Employer; and (3) prior to such disclosure, each such third party
shall enter into a confidentiality agreement (or an appropriate amendment to an existing one, as applicable)
ARTICLE 7 - CLAIMS RUNOUT SERVICES
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.
Employer shall notify Anthem monthly of the Subscribers, dependents, or other individuals that will be or
have become ineligible for benefits under the Plan. Upon receipt of such notice, Anthem shall terminate
coverage effective as of the date specified in the Benefits Booklet. Employer shall give Anthem advance
notice, if possible, of any Member's expected termination and/or retirement. Anthem reserves the right to
limit retroactive terminations to a maximum of 60 days prior to the date notice is received. Anthem shall
