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<br />EXHIBITC <br /> <br />GROUP BENEFITS SERVICES AGREEMENT <br />NON-PARTICIPATING <br /> <br />This Agreement is between the Employer named in the Schedule and the Texas Municipal League Group <br />Benefits Risk Pool, 1821 Rutherford Lane, Suite 300, Austin, Texas 78754 <br /> <br />SCHEDUI,E <br /> <br />1. Employer: City oCParis <br />2. Place of Delivery: Austin, Texas <br />3. Effective Date: May 1, 1999 <br />4. Monthly Service Charge per employee per month: <br /> <br />. <br /> <br />Claims Administration <br />Medical <br />Dental <br />Vision <br />Utilization Review <br />PPO Access Fee <br /> <br />$8.00 <br />$0.90 <br />$0.00 <br />$1.75 <br />$2.50 <br /> <br />. <br /> <br />. <br /> <br />5. Optional Services (per employee per month) <br /> <br />. <br /> <br />Transplant Centers <br />First Call <br />High Risk Pregnancy <br />Medical Conversion <br />HIP AA Compliance Adm. <br /> <br />$0.40 <br />$ 0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br /> <br />. <br />. <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />6. <br /> <br />Total <br /> <br />$13.55 <br /> <br />HealthChex - AutoAudit <br />Large Case Management <br />Custom Claims Reports <br />Rx Card Claims <br />Benefit Booklets (every 2 years) <br />PPO Directories <br />Hospital Audit <br />Subrogation <br /> <br />No Charge <br />$90.00/hr as required <br />$150.00/programming hour <br />$ 0.50/c1aim <br />Included For Number oCEE Plus 10% <br />Included For Number oCEE Plus 10% <br />20% oCsavings - Outside Vendor <br />20% oCsavings - Outside Vendor <br /> <br />EXI1I13IT A <br />Page I 01S <br />