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<br />GROUP BENEFITS SERVICES AGREEMENT <br />NON-P ARTICIP ATING <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 />SCHEDULE <br /> <br />1. Employer: City of Paris <br />2. Place of Delivery: Austin, Texas <br />3. Effective Date: May 1, 1997 <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 />$ 6.75 <br />$ 0.80 <br />$0.00 <br />$ 1.60 <br />$ 1.25 <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 />$ 0.15 <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 /> <br />6. <br /> <br />Total <br /> <br />$10.55 <br /> <br />Health Check - AutoAudit <br />Large Case Management <br />Custom Reports (l/yr included) <br />Rx Card Claims <br />PPO Directories <br /> <br />No Charge <br />$65.00/hr as required <br />$60~00/programming hour <br />$ 0.56/claim <br />Actual Cost <br /> <br />EXHIBIT A <br /> <br />P'lor 1 or ~ <br />