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HomeMy WebLinkAboutAnthem Stop LossAnthem. d Health. Join In STOP LOSS POLICY This policy is entered into by and between City of Carmel ( "Employer ") and Anthem Insurance Companies, Inc. d.b.a. Anthem Blue Cross and Blue Shield ( "Anthem ") for the purpose of establishing stop loss coverage and is effective as of January 1, 2015 upon the terms and conditions herein ( "Policy'). If there are any inconsistencies between this Policy and any prior stop loss agreements or the Administrative Services Agreement between Anthem and Employer, the terms and conditions of this Policy shall control. In consideration of the promises and the mutual covenants contained in this Policy, Anthem and Employer (the 'Party' or "Parties" as appropriate) agree as follows: ARTICLE 1 DEFINITIONS For purposes of this Policy and any amendments, attachments, or schedules to this Policy, the following words and terms have the following meanings unless the context or use clearly indicates another meaning or intent. If a term is not defined, the term shall have the same meaning as defined in the Administrative Services Agreement between the Parties. AGGREGATE STOP LOSS LIMIT. The threshold total dollar amount of Paid Claims for which Employer is financially responsible. Anthem is financially responsible for Paid Claims in excess of the Aggregate Stop Loss Limit according to the terms of this Policy. CLAIMS RUN -IN. Claims that are Incurred prior to the effective date of this Policy and processed by a third party administrator other than Anthem. ELIGIBLE CLAIM DATE PERIOD. The dates during which Claims for benefits provided under the terms of the Plan must be Incurred and paid in order to be covered by this Policy. INCURRED. The date on which a supply is obtained or a service is rendered to a Member. LINES OF COVERAGE. The benefit plan(s) administered by Anthem and provided in Schedule A. MINIMUM AGGREGATE STOP LOSS LIMIT. Notwithstanding the calculation of the Aggregate Stop Loss Limit, there is an amount identified in Section 5(b) of Schedule A as the Minimum Aggregate Stop Loss Limit. When the calculation of the Aggregate Stop Loss Limit results in a lower amount than the Minimum Aggregate Stop Loss Limit, the Minimum Aggregate Stop Loss Limit shall be the Aggregate Stop Loss Limit. PAID CLAIM. A Claim for services rendered or supplies provided to a Member under the terms of the Plan, provided such Claim has been received and adjudicated by Anthem. Paid Claim shall have the same meaning as contained in the Administrative Services Agreement between the Parties, unless specifically excluded as indicated in Sections 4(e) and 5(d) of Schedule A. SPECIFIC STOP LOSS LIMIT. The threshold total dollar amount of Paid Claims for which Employer is financially responsible with respect to a Subscriber or Member as indicated in Section 4(a) of Schedule A. Subject to the terms of this Policy, Anthem is financially responsible for Paid Claims in excess of the Specific Stop Loss Limit. ARTICLE 2 SPECIFIC STOP LOSS COVERAGE 2.1 When the total amount of Paid Claims pertaining to Subscribers or Members and Lines of Coverage provided in Sections 4(a) and 4(b) of Schedule A exceeds the Specific Stop Loss Limit provided in Section 4(c) of Schedule A, Anthem shall reimburse Employer for such excess. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. However, Anthem's reimbursement under this Article 2 shall begin with the invoice on which the Specific Stop Loss Limit is exceeded. 2.2 In the event that the Specific Stop Loss Limit is reached, no amount in excess of the Specific Stop Loss Limit shall be applied towards attainment of any Aggregate Stop Loss Limit. 2.3 Certain Paid Claims may be excluded from the specific stop loss coverage provided in this Policy. These exclusions are provided in Section 4(e) of Schedule A as applicable. ARTICLE 3 AGGREGATE STOP LOSS COVERAGE 3.1 The Aggregate Stop Loss Limit is the sum of the amounts derived by multiplying the applicable aggregate stop loss amount by the actual number of Subscribers or Members, provided in Section 5(b) of Schedule A, for all months in the Policy Period. In no event shall the Aggregate Stop Loss Limit fall below the Minimum Aggregate Stop Loss Limit during a Policy Period or a partial Policy Period. 3.2 When the total amount of Paid Claims for all Subscribers or Members and the Lines of Coverage indicated in Sections 5(a) and 5(b) of Schedule A exceeds the Aggregate Stop Loss Limit, Anthem shall reimburse Employer for such excess. Anthem's reimbursement under this Article 3 shall occur no later than 90 days following the end of the Eligible Claim Date Period. All Lines of Coverage that are subject to aggregate stop loss coverage shall be combined for purposes of calculating amounts owed under this Policy. 3.3 Certain Paid Claims may be excluded from the aggregate stop loss coverage provided in this Policy. These exclusions are provided in Section 5(d) of Schedule A as applicable. ARTICLE 4 LIMITATIONS ON COVERAGE 4.1 Unless otherwise noted in Schedule A, Paid Claims for Members are covered under the term of the Eligible Claim Date Period of this Policy. 4.2 Claims that are covered by another contract shall not count toward the attainment of the stop loss limit(s) under this Policy. In addition, Paid Claims that are covered under the term of an Eligible Claim Date Period will not count toward attainment of any stop loss limit(s) under a subsequent Policy Period. 4.3 Under the Administrative Services Agreement, the Employer may request Anthem to process and pay Claims that were denied by Anthem or take other actions with respect to the Plan that are not specifically provided under the Plan. In such cases, payments shall not count toward the stop loss accumulators under this Policy unless otherwise agreed to in writing by Anthem. 4.4 If a Member does not enroll when first eligible or within the applicable enrollment period provided in the Plan for a special enrollment event, the Member shall be considered a "Late Enrollee" as defined under the Plan. Paid Claims for a Late Enrollee shall not apply towards the stop loss limits under this Policy unless Anthem first provides Employer with written approval and the effective date of coverage under this Policy. Anthem has the right to allow or deny stop loss coverage under this Policy for a Late Enrollee. Anthem shall not cover under this Policy any Late Enrollee not disclosed by the Employer to Anthem. 4.5 A Claim incurred during the Eligible Claim Date Period but not paid until after the expiration of the Eligible Claim Date Period is not eligible for coverage under this Policy Period. Employer may pursue stop loss coverage under this Policy only if Employer demonstrates that Anthem acted in bad faith to delay processing and payment of the Claim until after the expiration of the Eligible Claim Date Period. ARTICLE 5 SETTLEMENT 5.1 Within 120 days after the end of each Eligible Claim Date Period (or after the termination of this Policy and any applicable Claims Run -out), Anthem shall furnish Employer with a settlement calculation and any additional data which, in Anthem's opinion, is needed to explain to Employer the settlement calculation. Stop Loss Agreement 2 City of Carmel dated January 1, 2015 Anthem has the right to offset any amounts owed by Employer under this Policy or the Administrative Services Agreement against any amounts owed by Anthem to Employer. 5.2 If, based on the settlement calculation for a Policy Period, Anthem must pay Employer an amount due under the terms of this Policy, Anthem shall pay Employer no later than 90 days after the settlement calculation subject to any right to offset any amounts owed to the Employer. If, based on the settlement calculation Employer must pay Anthem an amount under the terms of this Policy, then Employer shall pay Anthem no later than 90 days following receipt of the invoice. ARTICLE 6 STOP LOSS PREMIUM RATES The premium rates for the specific stop loss coverage provided in this Policy are indicated in Section 4(d) of Schedule A. The premium rates for the aggregate stop loss coverage provided in this Policy are indicated in Section 5(c) of Schedule A. Employer shall pay Anthem such amounts by the Invoice Due Date. ARTICLE 7 LATE PAYMENT PENALTY If Employer fails to timely pay any amount due to Anthem under this Policy, Employer shall pay a late payment penalty for each day the payment is late. The late payment penalty shall be calculated at the rate of 12% simple interest per annum (365 days), and shall be included on a subsequent invoice and payable by the Invoice Due Date. If applicable, Employer agrees to reimburse Anthem for any expenses charged to Anthem by a financial institution, Provider or Vendor due to Employer's failure to maintain sufficient funds in a designated bank account. Any acceptance by Anthem of late payments shall not be deemed a waiver of its rights to terminate this Policy for any future failure of Employer to make timely payments. ARTICLE 8 CHANGES IN TERMS OR CONDITIONS 8.1 If Anthem offers to renew this Policy at the end of a Policy Period, then Anthem shall provide Employer with the terms and conditions of the proposed renewal in writing within the time period provided in Section 1 of Schedule A. The Employer shall notify Anthem in writing of its selection from the renewal options by indicating its selection and signing Anthem's designated renewal form. If Anthem does not receive a signed acceptance of the renewal from Employer prior to the start of the next Policy Period, the Employers payment of the amounts provided in the renewal shall constitute Employer's acceptance of the terms. Anthem shall provide a revised Schedule A that will become part of this Policy without the necessity of securing Employer's signature. 8.2 Anthem reserves the right to make changes to this Policy, to Schedule A, or other applicable Run -in or Run - out Schedules at a time other than the start of a Policy Period upon the occurrence of one or more of the following events: (1) a change to the Plan benefits initiated by Employer that results in a substantial change in the services as determined by Anthem; (2) a change in ownership (including but not limited to a merger, consolidation, or transfer of all or substantially all of Employer's assets); (3) a change in the total number of Members resulting in either an increase or decrease of 10% or more of the number of Members enrolled for coverage on the date the stop loss premium was last modified; (4) a change in the Employer contribution; (5) a change in the nature of Employer's business resulting in a change in its designated Standard Industrial Classification ( "SIC ") code; or (6) a change in applicable law affecting this Policy or any of the Plan Documents. Anthem shall provide notice to Employer of any change at least 30 days prior to the effective date of such change. If such change is unacceptable to Employer, either Party shall have the right to terminate this Policy by giving written notice of termination to the other Party before the effective date of the change. If Employer accepts the proposed change, Anthem shall provide a revised Schedule A that will then become part of this Policy without the necessity of securing Employer's signature on the Schedule A. Stop Loss Agreement 3 City of Carmel dated January 1, 2015 8.3 No modification or change in any provision of this Policy, including but not limited to, changes at renewal, shall be effective unless and until approved in writing by an authorized representative of Anthem and evidenced by an amendment or new Schedule attached to this Policy. 8.4 Any payments made under this Policy shall only be for the benefit of Employer. Anthem has no obligation or liability under this Policy to provide benefits to Subscribers or Members. No Subscriber or Member shall have the right to any of the proceeds of any stop loss insurance obtained by Employer pursuant to this Policy. ARTICLE 9 SUBROGATION AND OTHER RECOVERIES Any subrogation or other recovery received by the Plan will not be used to satisfy any of the stop loss limits under this Policy. Anthem will first be repaid any amounts it has reimbursed under this Policy or under a previous stop loss agreement between the Parties. Any remaining recovery amounts shall be credited or paid to Employer as described in the Administrative Services Agreement. ARTICLE 10 TERMINATION 10.1 This Policy automatically terminates as follows: 10.1.1 At the end of each Policy Period unless the Policy is renewed pursuant to Article 8 of this Policy. 10.1.2 Upon the termination of the Administrative Services Agreement. 10.1.3 At the end of the month in which fewer than 90 Subscribers are covered under the Plan. 10.1.4 If Employer changes to a third party administrator other than Anthem for the Claims that are subject to this Policy. Upon termination of this Policy, the Parties shall remain liable for all payments due under this Policy. 10.2 The Employer may terminate this Policy at any time other than at the end of a Policy Period by giving Anthem 90 days written notice of its intent to terminate. 10.3 Notwithstanding any other provision of this Article 10, this Policy automatically terminates, without further notice or action, if Employer fails to pay any premium amounts due under this Policy within 30 days of the date of Anthem's notice to the Employer of a delinquent amount owed ("Grace Period "). Such termination shall be effective as of the last' period for which full payment was made. During the Grace Period, the stop loss coverage will remain in effect provided the premium is paid before the end of the Grace Period. Any acceptance of a delinquent payment by Anthem shall not be deemed a waiver of this provision for termination of this Policy. Delivery of payment to Anthem or Anthem's receipt and negotiation of a tendered payment through its automatic deposit procedures shall not be deemed acceptance or a waiver of such termination. If this Policy is terminated due to nonpayment of premium, Claims Run -out coverage, if any, will not apply. 10.4 Notwithstanding any other provision of this Policy, if Employer engages in fraudulent conduct or misrepresentation, Anthem may rescind, cancel, or terminate this Policy, effective on the date of the fraudulent conduct or misrepresentation regardless of the date Anthem's discovered such conduct. Employer shall be liable to Anthem for any and all payments made, as well as losses or damages sustained by Anthem arising as a result of such Employer conduct. 10.5 In the event that this Policy terminates or is terminated prior to the end of a Policy Period, the stop loss limits under this Policy shall not be prorated, and Anthem shall not reimburse Employer for any Paid Claims unless the Specific Stop Loss Limit and/or the Aggregate Stop Loss Limit or the Minimum Aggregate Stop Loss Limit, if greater, have been met. Only amounts accumulated towards any stop loss limits under this Policy through the date of termination will be used in the determination of whether such limits have been met. Anthem shall have no obligation to refund to Employer any stop loss premiums paid by Employer under this Policy. Stop Loss Agreement 4 City of Carmel dated January 1, 2015 If, based on the settlement calculation, Anthem must pay Employer an amount due under the terms of this Policy, Anthem shall pay Employer no later than 90 days after the settlement calculation subject to any right to offset any amounts owed to the Employer. If, based on the settlement calculation Employer must pay Anthem an amount under the terms of this Policy, then Employer shall pay Anthem no later than 90 days following receipt of the invoice. ARTICLE 11 NOTICES Notices under this Policy shall be deemed sufficient when made in writing as follows: to Employer, by first class mail, personal delivery, electronic mail or overnight delivery with confirmation capability, to its principal office shown upon the records of Anthem; to Anthem, by first class mail, personal delivery, electronic mail or overnight delivery with confirmation capability, to the designated Anthem sales representative. 11.2 A notice or demand shall be deemed to have been given as of the date of deposit in the United States mail with postage prepaid or, in the case of delivery other than by mail, on the date of actual delivery at the appropriate address. ARTICLE 12 GENERAL PROVISIONS 12.1 No failure or delay by either Party to exercise any right or to enforce any obligation herein and no course of dealing between Employer and Anthem shall operate as a waiver of such right or obligation or be construed as or constitute a waiver of the right to enforce or insist upon compliance with such right or obligation in the future. Any single or partial exercise of any right or failure to enforce any obligation shall not preclude any other or further exercise or the right to exercise any other right or enforce any other obligation. 12.2 Unless it has first obtained the written consent of an officer of the other Party, neither Party may assign this Policy to any other person. Notwithstanding the foregoing, Anthem may, with advance written notice to Employer, assign or otherwise transfer its rights and obligations hereunder, in whole or in part, to: (i) any affiliate of Anthem; or (ii) any entity surviving a transaction involving the merger, acquisition, consolidation, or reorganization of Anthem, or in which all or substantially all of Anthem's assets are sold. Additionally, Employer may, with advance written notice to Anthem, assign, delegate, or otherwise transfer its rights and obligations hereunder, in whole, to (i) any affiliate of Employer; or (ii) any entity surviving a transaction involving the merger, acquisition, consolidation or reorganization of Employer, or in which all or substantially all of Employer's assets are sold, provided that such affiliate or other assignee presents, in Anthem's opinion, an equivalent or better financial status and credit risk. Either Party is required to provide advance written notice under this provision only to the extent permissible under applicable law and the reasonable terms of the agreement(s) governing such merger, acquisition, consolidation, reorganization, or asset sale. If advance written notice is not allowed, notice shall be provided as soon as practicable. Upon receipt of notice of an assignment of this Policy, the other Party may terminate this Policy by providing the assigning Party with 30 days advance written notice of termination. Any assignee of rights or benefits under this Policy shall be subject to all of the terms and provisions of this Policy. Either Party may subcontract any of its duties under this Policy without the prior written consent of other Party; however, the Party subcontracting the services shall remain responsible for fulfilling its obligations under this Policy. 12.3 The payment of amounts under this Policy will not include any taxes which might be paid or payable by Employer; or any tax liability, interest or penalty imposed by any regulatory or taxing authority. Employer agrees to pay Anthem for any tax liability assessed against Anthem on the basis of the stop loss coverage provided to Employer and shall reimburse Anthem for the amount of any such tax liability incurred by Anthem as the result of such tax assessment. Such reimbursement shall be due and payable when Employer receives Anthem's notification that reimbursement is due. 12.4 No action by either Party alleging a breach of this Policy may be commenced after the expiration of 3 years from the date on which the claim arose. 12.5 Employer on behalf of itself and its participants, hereby expressly acknowledges its understanding that this Policy constitutes a contract solely between Employer and Anthem, that Anthem is an independent Stop Loss Agreement 5 City of Cannel dated January 1, 2015 corporation operating under a license with the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans, permitting Anthem to use the Blue Cross and Blue Shield Service Marks in the State of Indiana and that Employer further acknowledges and agrees that it has not entered into this Policy based upon representations by any person other than Anthem and that no person, entity, or organization other than Anthem shall be held accountable or liable to it for any of Anthem's obligations to Employer created under this Policy. This paragraph shall not create any additional obligations whatsoever on the part of Anthem other than those obligations created under other provisions of this Policy. 12.6 If there is a conflict between the terms and conditions of this Policy and the Administrative Services Agreement between the Parties, the terms and conditions of this Policy shall prevail. 12.7 Anthem agrees that it will not terminate this Policy during an Eligible Claim Date Period due to adverse claim experience of Member(s). ARTICLE 13 ENTIRE AGREEMENT 13.1 The following documents will constitute the entire description of stop loss coverage between the Parties: this Policy, including any applications, amendments and Schedules thereto. 13.2 This Policy supersedes any and ail prior agreements between the Parties, whether written or oral, and other documents, if any, addressing the subject matter contained in this Policy. 13.3 If any provision of this Policy is held to be invalid, illegal or unenforceable in any respect under applicable law, order, judgment or settlement, such provision shall be excluded from the Policy and the balance of this Policy shall be interpreted as if such provision were so excluded and shall be enforceable in accordance with its terms. IN WITNESS WHEREOF, the Parties hereto have caused this Policy to be executed in duplicate by affixing the signatures of duly authorized officers. City of Carmel Anthem Insurance Companies, Inc. d.b.a. Anthem Blue Cross and Blue Shield '40-- By: (((/// ___ / By: Robert W. Hillman Title: Title: President Anthem Rive Cross and Rlue Shield Date: Date: December 10, 2014 Stop Loss Agreement 6 City of Carmel dated January 1, 2015 SCHEDULE A to the STOP LOSS POLICY with CITY OF CARMEL Section 1. Term The Policy Period shall be from January 1, 2015 through December 31, 2015. For purposes of this Policy Period, this Schedule shall supplement and amend the Stop Loss Policy between the Parties. Anthem shall provide an offer to renew this Policy at least 120 days prior to the end of a Policy Period. Jurisdiction of this Policy shall be in the state of Indiana. Section 2. Eligible Claim Date Period Claims under the Plan shall be covered by the Stop Loss Policy when Incurred and paid as follows: Incurred from July 1, 2014 through December 31, 2015 and Paid from January 1, 2015 through December 31, 2015 The Eligible Claim Date Period applies only to a full Policy Period. Section 3. Member Excluded from Stop Loss Coverage Not Applicable Section 4. Specific Stop Loss Coverage A. Application of Specific Stop Loss Coverage Amounts accumulated toward the Specific Stop Loss Limit shall be calculated as follows: Per Member B. Lines of Coverage The specific stop loss coverage shall apply to the following benefits under the Plan: Medical / RX C. Specific Stop Loss Coverage Limits Specific Stop Loss Limit $175,000.00 D. Premium Rates The per Subscriber Premium Rates for the specific stop loss coverage shall be the following: Medical / RX Composite $102.82 /mo. Stop Loss Agreement 7 City of Carmel dated January 1, 2015 E. Paid Claims For purposes of specific stop loss coverage, Paid Claims shall not include the followinq: Dental Vision Comprehensive Health Solutions Program Fees Claim surcharges to the extent that such surcharges are not included in the Paid Claim amount Funds representing Employer allocation to Consumer Directed Health Plan accounts NCN Fee Section 5. Aggregate Stop Loss Coverage A. Lines of Coverage The aggregate stop loss coverage shall apply to the following benefits under the Plan. Medical / RX B. Aggregate Stop Loss Coverage Limits Aggregate Stop Loss Amount. The aggregate stop loss amount used to determine the Aggregate Stop Loss Limit shall be calculated with the following: Per Subscriber Medical / RX Composite $1,854.12 per Subscriber per month Minimum Aggregate Stop Loss Limit $12,090,374.65 C. Premium Rates The per Subscriber Premium Rates for the aggregate stop loss coverage shall be the following: Medical / RX Composite D. Paid Claims $10.86 /mo. For purposes of aggregate stop loss coverage, Paid Claims does not include the followinq: Dental Vision Comprehensive Health Solutions Program Fees Claim surcharges to the extent that such surcharges are not included in the Paid Claim amount Funds representing Employer allocation to Consumer Directed Health Plan NCN Fee accounts Section 6. Payment ACH or Wire Transfer Reimbursement. Employer shall deposit the amount due in a designated Anthem bank account by the Invoice Due Date. The deposit shall be made in accordance with any policies and regulations of the bank necessary to assure that the deposit is credited to Anthem's account no later than the next business day. Stop Loss Agreement 8 City of Carmel dated January 1, 2015 Section 7. Premium Credit Anthem will not credit premium that relate to retroactive deletions and conversely, Anthem will not charge, and Employer shall not pay, premium that relate to retroactive additions to enrollment. Section S. Liability Maximum This Section has been intentionally omitted. Section 9. Other Amendments This Policy is otherwise amended as follows: Broker or Consultant Base Compensation Broker or Consultant Fee is 12.5% of the premium paid under this Policy. Upon receipt of payment from Employer, Anthem shall remit payment to the broker or consultant designated by Employer. The following definition "INVOICE DUE DATE" is added: INVOICE DUE DATE. The date on the invoice provided to Employer indicating when payment is due. The following definition "POLICY PERIOD" is added: POLICY PERIOD. The term defined in Section 1 of Schedule A. CITY OF CARMEL, INDIANA By and through its Board of Public Works and Safety BY: James Brainard, Presiding Officer Mgry Ant Date: Lori S. Watsbl<Member Date: i1 /ti /,y ATTEST: Anthem Insurance Companies, Inc. d.b.a. Anthem Blue Cross and Blue Shield Di a Cordray, IMCA, CI ate: /4— = Teysur • r / / / w. dcd -- BY Robert W Hillman Title: President, Anthem Blue Cross and Blue Shield Date: December 10, 2014 Stop Loss Agreement - 9 City of Carmel dated January 1, 2015 RUN -IN SCHEDULE to the STOP LOSS POLICY with CITY OF CARMEL This Schedule to the Stop Loss Policy is effective January 1, 2015, This Schedule describes the stop loss coverage applicable to Claims Run -in and shall supplement and amend the Stop Loss Policy between the Parties. If there are any inconsistencies between the terms of the Policy and this Schedule, the terms of this Schedule shall control. Additionally, if there are any inconsistencies between the terms of Schedule A and this Schedule, the terms of this Schedule shall control unless otherwise expressly addressed herein. All remaining terms of Schedule A shall apply to this Schedule. Specific Stop Loss Coverage Applicable to Claims Run -in Claims Run -in Period Applicable to Specific Stop Loss Coverage Anthem shall count towards the Specific Stop Loss Limit described in this Policy Claims Incurred during the 6 month period preceding the Effective Date of this Policy ( "Claims Run -in Period ") and paid by a third party administrator other than Anthem. The Employer must provide a monthly report in a format approved by Anthem that lists the total Paid Claims for the Claims Run -in Period. Anthem shall not reimburse Employer any amount due under this Policy until it has received the final report of Paid Claims for the Claims Run -in Period. Anthem shall not count towards the applicable stop loss limits any Claims Incurred during the Claims Run -in Period and processed by another third party administrator that are submitted to Anthem later than 60 days following the end of the Eligible Claim Date Period. Aggregate Stop Loss Coverage Applicable To Claims Run -in Claims Run -in Period Applicable to Aggregate Stop Loss Coverage Anthem shall count towards the Aggregate Stop Loss Limit described in this Policy Claims Incurred during the 6 month period preceding the Effective Date of this Policy ( "Claims Run -in Period ") and paid by a third party administrator other than Anthem. The Employer must provide a monthly report in a format approved by Anthem that lists the total Paid Claims for the Claims Run -in Period. Anthem shall not reimburse Employer any amount due under this Policy until it has received the final report of Paid Claims for the Claims Run -in Period. Anthem shall not count towards the applicable stop loss limits any Claims Incurred during the Claims Run -in Period and processed by another third party administrator that are submitted to Anthem later than 60 days following the end of the Eligible Claim Date Period. Other Amendments. This Policy is otherwise amended as follows: Paid Claims shall include Claims administered by Benefit Administrative Systems, LLC Claims Run -In is limited to Claims that are Incurred but unreported and /or unpaid as of the date of this Policy and processed and Paid by a third party administrator other than Anthem. The Run -in specific stop loss coverage shall apply to the following benefits under the Plan. Medical / RX The Run -in aggregate stop loss coverage shall apply to the following benefits under the Plan. Medical / RX City of Carmel Anthem Insurance Companies, Inc. d.b.a. Anthem Blue Cross and Blue Shield By: Title: Date: L2 - /7-/ 5` a dal— By: Robert W. Hillman Title: President, Anthem Blue Cross and Blue Shield Date: December 10, 2014 Stop Loss Agreement 10 City of Carmel dated January 1, 2015