Finance Committee

t. If a catastrophic event (whether weather-related, caused by a natural disaster, or caused by war, terrorism,
or similar event) occurs that affects Members in one or more locations, and such catastrophic event
prevents or interferes with Anthem's ability to conduct its normal business with respect to such Members or
prevents or interferes with Members’ ability to access their benefits, Anthem shall have the right, without
first seeking consent from Employer, to take reasonable and necessary steps to process Claims and

2. Perform case management to identify short and long term treatment programs in cases of severe
or chronic illness or injury. Anthem may, but is not required to, customize benefits in limited
circumstances by approving otherwise non-Covered Services if, in the discretion of Anthem, such
exception is in the best interest of the Member and the Plan.

3. Provide access to a specialty network of Providers if the Plan includes a specialty network.
Anthem reserves the right to establish specialty networks for certain specialty or referral care.

3. Provide notice in writing when a Claim for benefits has been denied which notice shall set forth the
reasons for the denial and the right to a full and fair review of the denial under the terms of the
Benefits Booklet and shall otherwise satisfy applicable regulatory requirements, including those of
ERISA, governing the notice of a denied Claim.

PLAN DOCUMENTS. The documents that set forth the terms of the Plan, and which include the Summary Plan
Description and the Benefits Booklet.

PRESCRIPTION DRUG. Insulin and those drugs and drug compounds that are included in the U.S. Pharmacopoeia
and that are required to be dispensed pursuant to a prescription or that are otherwise included on Anthem's formulary
(e.g., certain over-the-counter drugs).

INTER-PLAN PROGRAMS. Blue Cross and Biue Shield Association programs, inciuding the BlueCard Program,
where Anthem can process certain Claims for Covered Services received by Members, which may include accessing
the reimbursement arrangement of a Provider that has contracted with another Blue Cross and/or Blue Shield plan.

INVOICE DUE DATE. The date on the invoice provided to Employer indicating when payment is due.

ADMINISTRATIVE SERVICES AGREEMENT

This Administrative Services Agreement ("Agreement") is entered into by and between City of Nashua ("Employer")
and Anthem Health Plans of New Hampshire, Inc. dba Anthem Blue Cross and Blue Shield ("Anthem") and is
effective as of July 1, 2013 upon the following terms and conditions:

1. Employer is the sponsor of a self-funded Group Health Plan (as defined below) providing, among other
things, health care benefits to certain eligible employees and their qualified dependents.

The Hartford

City of Nashua

Human Resources Department
229 Main Street - Nashua, NH 03060

603 589-3230
To: Dan Kooken, Purchasing Manager
From: Larry Budreau, Human Resources Director

Subject: Anthem BlueCross BlueShield Administrative Services Contract Renewal
Harvard Pilgrim HealthCare Administrative Services Contract Renewal
The Hartford - Life Insurance, Supplemental Life, and AD&D Contract Renewal

Date: May 10, 2016

>, THE CITY OF NASHUA "The Gate City"

Financial Services

Purchasing Department

pea A Bae te Pe Rn at GR tt sac eked SH i Bt aU ts A RARER NN tp ee A ar SO A

May 12, 2016
Memo #16-140

TO: MAYOR DONCHESS
FINANCE COMMITTEE

SUBJECT: TO APPROVE CONTRACTS FOR ADMIN SERVICES TO ANTHEM BLUECROSS AND
BLUE SHIELD, HARVARD PLIGRIM HEALTHCARE AND THE HARTFORD (VALUE:
NOT TO EXCEED $1,395,000)
DEPARTMENT: HUMAN RESOURCES; FUND: BENEFITS SELF INSURANCE FUND

IN WITNESS WHEREOF, the parties hereto have caused this contract to be signed and intend to be legally
bound thereby.

City of Nashua, NH (signature) Contractor (signature)

James Donchess, Mayor
(Printed Name and Title) (Printed Name and Title)

Date Date

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