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<br />GROUP BENEFITS SERVICES AGREEMENT <br />NON-PARTICIPATING <br /> <br />This Agrcemenl is between the Employ~r named in thc Schedule and the TML Inteq;ovenunental <br />Employee Benelits Pool, 1821 Rutherford Lane, Suite 300, Austin, Texas 78754 <br /> <br />SCHEDULE <br /> <br />\. Employer: City of Paris <br />2. :Place of Delivery: Austin, Texas <br />3. Effective Date: May 1,2000 <br />4. Monthly Service Charge per employec per month: <br /> <br />. <br /> <br />Claims Administration <br />Medical <br />Dental <br />Vision <br />Utilization Rcview <br />PPN Access Fec <br /> <br />S8.00 <br />50.90 <br />SO,40 <br />S 2.00 <br />$3.00 <br /> <br />. <br /> <br />. <br /> <br />5. Optional Services (per employee pcr month) <br /> <br />. <br /> <br />First Call <br />High Risk Prcgnaney <br />Medical Conversion <br />HIPAA Compliance Adm. <br />COC Administration <br /> <br />SO.OO <br />50.00 <br />SO.OO <br />SO.OO <br />SO.50 <br />SO,OO <br />SO.OO <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />6. <br /> <br />Total <br /> <br />514.80 <br /> <br />HealthChex - AutoAudit <br />Large Case Managemcnl <br />Transplant Centers <br />Custom Claims Reports <br />Rx Card Claims <br />Benefit Booklets (every 2 years) <br />PPN Directories <br />Retiree Dm."'Ct Billing <br />Hospital Audit <br />Subrogation <br /> <br />No Charge <br />Included in UR Fee <br />Included in PPN Fee <br />S150.00fprogramming hour <br />S 0.32fclaim <br />lucluded For Number of EE Plus 10':1. <br />Included For Numbe.' ofEE Plus 10% <br />51,OOfmonlhfemployee <br />20% oCsaviugs - Outside Vendor <br />20% of savings - Outside V cndor <br /> <br />Note I - PPN AecC$S Fcc Includes Full Network <br /> <br />Pace 1 nf, <br />EXHIBIT "An <br />