SERVICE AGREEMENT FOR
DEPENDENT ELIGIBILITY VERIFICATION SERVICES
This AGREEMENT FOR DEPENDENT ELIGIBILITY VERIFICATION SERVICES (this
“Agreement’) is entered into by and between Part D Advisors, Inc., a Michigan corporation (hereinafter
referred to as “PDA”) and the City of Nashua (hereinafter referred to as “Plan Sponsor’) on behalf of
itself and the City of Nashua Health Plan (hereinafter referred to as the “Plan”) and shall be effective as
of December 8, 2020 (the “Effective Date’’).
RECITALS
WHEREAS, Plan Sponsor maintains a group health program;
WHEREAS, Plan Sponsor has established specific eligibility criteria for participation in the Plan;
WHEREAS, Plan Sponsor wishes to engage PDA in verifying dependents and the associated eligibility
criteria of the Plan;
WHEREAS, Plan Sponsor (or its designee(s) other than PDA) shall serve as the administrator, fiduciary
and primary decision maker for the Plan, with all of the rights and responsibilities for administering the
Plan, and PDA shall have no such authority or responsibility except as may be specifically provided
herein;
WHEREAS, Plan Sponsor and PDA entered into a Business Associate Agreement effective October 30,
2017 which is thereby incorporated into this Agreement.
NOW THEREFORE, in consideration of the mutual covenants and agreements herein contained, the
parties agree as follows:
SECTION 1
PDA SERVICES
1.01 Specific PDA Services — Dependent Eligibility Verification. During the term of this Agreement,
PDA shall provide any or all of the following services as may be necessary to complete the
verification of Plan’s dependents’ eligibility for group medical and/or dental insurance:
(a) Create a project timeline specifying the dates of meetings, mailings, deliverables and
final reporting;
(b) Customize mailings based on Plan eligibility criteria, including a list of acceptable proof
documents (one proof document per dependent);
(c) Provide up to three separate mailings to Plan members requesting their documents for
validation, the first of which will include prepaid business reply mail (BRM) envelopes;
City of Nashua 1 DEV SA Revised January 2020
