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C97-102 Sloans Lake Managed Care Inc
CCC.W1O24SloansLakeManagedCare,Inc.EXCLUSIVEPARTICIPATIONAGREEMENTThisParticipationAgreementiseffectivethe1stdayofSeptember,1996,byandbetweenEagleCountyGovernment(hereinafterreferredtoas“ParticipatingPlan”)andSloansLakeManagedCare,Inc.,aColoradocorporation,(hereinafterreferredtoas“$LMC”).PREMISES1.$LMChasbeenformedforthepurposeofenteringintoagreementswiththirdparties(suchasinsurancecompanies,self-insuredmulti-employerplansandgovernmentalentities)forthedeliveryofhealthcarebySLMCParticipatingHealthcareProviderstotheemployees,membersorotherconstituentsofsuchthirdparties,aswellastheirdependents,hereinafterreferredtoas“CoveredIndividuals”.2.SLMCmaintainsanetworkofcontractedphysicians,hospitalsandprovidersofancillaryservicesavailableforusebyCoveredIndividualsofParticipatingPlan.3.ParticipatingHealthcareProviderswillacceptasthUpaymentSLMCnegotiatedfeesandcooperatewithSLMCpolicies.4.ParticipatingPlanwishestosecureforitsCoveredIndividualsthe$LMCnetworkofphysicians,hospitalsandancillaryserviceprovidersandtosecureforitselfthebenefitsofSLMCnetworksystem.Thereforeinconsiderationofmutualpromisescontainedherein,thepartiesagreeasfollows:ARTICLEIDEFINITIONS1.1“Coinsurance”or“Copavment”and“Deductible”meantheportionofpaymentduetheParticipatingHealthcareProviderfromtheCoveredIndividualforCoveredServicesunderthetermsoftheParticipatingPlan.1.2“CoveredIndividuals”meansthoseeligibleemployees,membersorotherconstituentsoftheParticipatingPlanaswellastheireligibledependents.PP0777/PAR.R.EXIEAGLE.COUNTY/9.18.96bh1 001.3“CoveredServices”meansHealthcareServiceswhichareprovidedtoCoveredIndividualsforwhichhealthbenefitsarereimbursablebytheParticipatingPlan.CoveredServicesincludestheportionofthefeenotreimbursedduetoapplicableCoinsurance,Copayments,andDeductiblesforwhichpaymentistheresponsibilityoftheCoveredIndividual.1.4“HealthcareServices”meansthoseservices,suppliesandfacilitiesnormallyprovidedbytheParticipatingHealthcareProviderandthatarewithinthescopeoftheParticipating.HealthcareProvider’slicenseandaccreditation.1.5“Hospital”meansanyhospital(orhospitals)whichis(are)dulylicensedintheStateofColoradoandaccreditedbytheJointCommissiononAccreditationofHealthcareOrganizations(JCAJ{O)(theJCAHOaccreditationrequirementmaybewaivedatthediscretionofSLMCiftheHospitalisMedicarecertified)andwhichcontractswithSLMCtoprovideHealthcareServices.1.6“Non-CoveredServices”meansHealthcareServicesprovidedtoCoveredIndividualswhicharenotcoveredaspartoftheParticipatingPlanor,ifcovered,arenotpayablebecauseoftheParticipatingPlan’sapplicablepenaltyprovisions,benefitmaximums,andutilizationreviewstandardsforwhichpaymentistheresponsibilityoftheCoveredIndividual.1.7“SLMC”meanstheintegratedsystemofaParticipatingHealthcareProvidernetwork,costmanagementprograms,negotiatedfees,providercommunicationsexpertise,andmanagementinformationsystemsofferedbySLMC.1.8“ParticipationAgreement”meansthisParticipationAgreementbetweentheparties.1.9“ParticipatingHealthcareProvider”meansanyPhysician,Hospital,ProviderofAncillaryServices,orpreferredproviderorganizationwhichhascontractedwith$LMCtoprovideHealthcareServicestoCoveredIndividualsandwhoarespecificallyincludedinthisParticipationAgreement.1.10“Physician”meansadulylicensedmedicaldoctorordoctorofosteopathywhoislegallypermittedtopracticemedicineandwhohascontractedwithSLMCtoprovideHealthcareServicestoCoveredIndividuals.1.11“ProviderofAncillaryServices”meansanyproperlylicensedand/orcredentialedproviderofhealthcareorotheralliedorrelatedproductsorserviceswhichdonotfitwithinthedefmitionofaHospitalorPhysician,andwhichcontractswithSLMCtoprovideHealthcareServicestoCoveredIndividuals.PPO777IPAR.R.EUEAGLE.COUNTY/9.18.96bh2 0C1.12“Repricing”meanstherecalculationofaclaimbasedontheratesoutlinedinExhibitsAandB.ARTICLEIINETWORKMANAGEMENT2.1$LMCshallrequireParticipatingHealthcareProviderstoacceptasfullpaymentSLMCnegotiatedfeesasoutlinedinExhibitsAandB,whichareattachedheretoandincorporatedbyreferenceherein,forCoveredServices.SLMCmayaddordeleteParticipatingHealthcareProviderstothisParticipationAgreementwithwrittennoticetotheParticipatingPlan.SuchwrittennoticeshallincludetheParticipatingHealthcareProvider’sExhibitAor3.Further,$LMCmay,fromtimetotime,negotiateandprovidetoParticipatingPlanupdatedExhibitsAandBforParticipatingHealthcareProviders.ParticipatingPlanshallpayclaimsinaccordancewithandotherwiseabidebysuchnewandupdatedExhibitsAand3.ParticipatingHealthcareProviderswillcollect,inaccordancewiththeirusualcollectionpractices,Non-CoveredServicesandportionsofanegotiatedratenotpaidbytheParticipatingPlanasaresultoftheParticipatingPlan’sCopayment,CoinsuranceorDeductibleprovisions.2.2SLMCagreestoensurethatallnewParticipatingHealthcareProvidersundergoacredenfialingprocessbeforeparticipationinSLMCandshallprovidepeerreviewserviceswithrespecttoPhysicianHealthcareServicesthatareprovidedunderthisParticipationAgreement.2.3TheconductofthepeerreviewfunctionsunderthisParticipationAgreementshallbethesoleresponsibilityofSLMC.TherightsoftheParticipatingPlanoritsCoveredIndividualsarenotlimitedbythisfunction.2.4SLMCagreestorequireallParticipatingHealthcareProviderstomaintainacurrentlicenseorcertificateauthorizingthemtodeliverHealthcareServicesintheStateofColorado.HospitalsmustbeproperlylicensedintheStateofColoradoandaccreditedbytheJointCommissiononAccreditationofHealthcareOrganizations(unlessgrantedawaiverbySLMC).PhysiciansmustmaintainstaffprivilegeswithatleastoneHospitalsubjecttothisParticipationAgreement,unlessthePhysician’spracticedoesnotrequirehospitalusage.2.5SLMCagreestorequireallPhysicianstocarrytheminimummalpracticeliabilityinsuranceintheamountrequiredbyColoradoStatelaw.SLMCagreestorequireallHospitalstocarrymalpracticeliabilityinsuranceormaintainaprogramofselffundingofinsuranceformalpracticeliabilityinsurance,inanamountdeemedadequateby$LMC.SLMCwillrequireallotherParticipatingHealthcareProviderstocarryprofessionalPP0777/PAR.R.EX!EAGLE.COUNTY/9.18.96bh3 00liabilityinsuranceinanamountdeterminedadeqtiatebySLMCtoinsureParticipatingHealthcareProviderandprovider’semployeesagainstliabilityfordamagesdirectlyorindirectlyrelatedtotheperformanceofParticipatingHealthcareProvider’sprofessionalactivities.2.6$LMCshallmpintainanappropriategeographicandspecialtydisthbutionofParticipatingHealthcareProviderswhichhaveagreedtocooperatewiththeSLMCsystem.2.7SLMCagreestoperiodicallyprovideinformationtoallParticipatingHealthcareProvidersandtheirstaffregardingParticipatingPlanandpoliciesandprocedureswithrespecttotheParticipatingPlan.2.8SLMCwillpublishannually,withoutcosttotheParticipatingPlan,adirectoryofthenamesofallParticipatingHealthcareProviders,theirrespectivespecialtiesandareaofpractice.SLMCwillprovidesufficientcopiesofthedirectorytotheParticipatingPlanfordistributiontoalleligibleemployeesonanannualbasis.AdditionaldirectoriescanbeprovidedtotheParticipatingPlanatcostplusshipping.Additionallistings,deletions,andotherchangestoparticipatingPhysiciansshallbecommunicatedtotheParticipatingPlan’sclaimsadministratorinwritingeveryforty-five(45)tosixty(60)daysbySLMC.2.9SLMCagreestoRepriceallParticipatingHealthcareProviderclaimsandattachaRepricingcoversheettotheclaimaspartoftheRepricingfeeunderArticleIV,Paragraph4.1.RepricingincludesclaimreviewonclaimsfromParticipatingHealthcareProvidersreimbursedaccordingtoExhibitsBformultiplesurgeries,RNEandBRcptcodes,andunlistedproceduresintheMcGrawHillRV$.ARTICLEifiCOMMUNICATIONS3.1SLMCagreestonotifyallParticipatingHealthcareProvidersofthisParticipationAgreement’seffectivedate.SLMCagreestomakereasonableeffortstoanswerquestionsregardingdirectoryinformationandadministrativeissueswhicharisefromCoveredIndividuals.AllquestionsfromCoveredIndividualsregardingthecontractofinsuranceshallbedirectedtotheParticipatingPlan’sclaimsadministrator.PPO7ThPAR.R.EXIEAGLE.COUNTY/9.18.96bh4 CCARTICLEIVPARTICIPATINGPLAN’SOBLIGATIONS4.1TheParticipatingPlanagreestopayanAdministrativefeeof$2.10peremployeepermonthandaRepricingFeeof$.75peremployeepermonth.SuchfeesshallbebasedonthenumberofemployeescoveredunderthisParticipationAgreementonthefirstdayofeachmonthandduenolaterthanthelastdayofthemonth.ParticipatingPlanshallprovideSLMCwithastatementlistingthenumberofemployeescoveredunderthisParticipationAgreementnolaterthanforty-five(45)daysfollowingtheexecutionofthisParticipationAgreementand,thereafteronamonthlybasis.ThisstatementshallaccompanyeachpaymentoftheAdministrativefee.ParticipatingPlanshallremitthefeesdirectlytoSloansLakeManagedCareat:SloansLakeManagedCare,Inc.1355SouthColoradoBlvd.,Ste.902Denver,CO80222Atm:FinanceDept.4.1.aLatepaymentchargeswillbecomputedattherateofoneandonehalfpercent(1.5%)oftheoverdueamountpermonthorthemaximumlawfulamount,whicheverisless.ParticipatingPlanwillalsobeliableforallcoststocollectanypastdueamounts,includinganycollectionagencyorattorneys’fees.Eachpaymentshallincludeastatementexplainingthebasisofcalculationsofthisfeeinaformatmutuallyagreeduponbytheparties.SLMCretainstherighttorequestindependentverificationofemployeelivesforanygivenmonth.4.2TheParticipatingPlanagreestoremitpaymentsduetoParticipatingHealthcareProviders,forCoveredServicesrenderedtoCoveredIndividuals,withinthetimeframesandintheamountsspecifiedoneachExhibitAandB,lessanyapplicableDeductible,Copayment,Coinsurance,orNon-CoveredServices,lithetimeframeisnotspecifiedonanExhibitAorB,ParticipatingPlanagreestheclaimshallbepaidwithinthirty(30)daysofreceiptbytheParticipatingPlan’sclaimsadministrator.4.2.aTheParticipatingPlanagreestoremitpaymentsdirectlytotheParticipatingHealthcareProvider,withoutthenecessityoftheParticipatingHealthcareProviderobtainingasignaturefromtheCoveredIndividualfortheassignmentofbenefits.4.2.bTheadministrationofallclaimsissolelytheresponsibilityoftheParticipatingPlan.TheParticipatingPlanshallbesolelyresponsib’efordeterminationofallquestionsconcerningclaims,payment,andtheeligibilityofanyindividualwhobenefitsfromtheParticipatingPlan.PPO777IPAR.R.EXIEAGLE.COUNTY/9.18.96bh5 004.3PaymentsordenialsofpaymenttoParticipatingHealthcareProvidersshallbeaccompaniedbyanExplanationofBenefits(EOB)whichlistseachdollaramountseparatelyforanyCopayment,Coinsurance,andDeductibleorNon-CoveredServiceamountstakenorappliedoneachclaim.TheseamountsmaybebilleddirectlytotheCoveredIndividualbytheParticipatingHealthcareProvider.TheExplanationofBenefits(EOB)shallalsolistseparatelyanydiscountstakenbasedonamountsspecifiedinExhibitsAandB.4.4ParticipatingPlanagreestocooperateandassistallpartiesinthecoordinationofbenefits.4.5SLMCacknowledgesthatCoveredIndividualsareresponsibleforNon-CoveredServices,CopaymentsorCoinsurance,andDeductiblesasdefmedbyParticipatingPlanandareultimatelyresponsibleforpaymenttotheParticipatingHealthcareProviderforsuchitems.ParticipatingPlanacknowledgesifCoveredServicesarenotpaidbytheParticipatingPlan’sclaimsadministratorwithinthetimeframesspecifiedinArticleIV,Paragraph4.2,thenpaymentofCoveredServicesisultimatelytheresponsibilityoftheCoveredIndividual.4.6IntheeventaParticipatingHealthcareProviderseeksoralverificationofaCoveredIndividual’seligibilityorinformationregardingthelevelofbenefitsoftheParticipatingPlan,theParticipatingPlanshallrequireitsclaimsadministratortoorallyconfirmsucheligibilityorprovidetheinformationrequestedbytheprovider.4.7ThepartiesagreethatifaparticipatingPhysicianbelievestheamountpaidisinerror,he/sheshallhaveninety(90)daysafterreceiptofpaymenttoquestiontheaccuracyofsuchamount.AftersuchtimetheamountpaidshallbebindingontheparticipatingPhysicianasthefullamountduetoPhysician.4.8ParticipatingPlanshallimmediatelynotifySLMCinwritingofanyamendmentsormaterialchangesinitsscheduleofbenefitspayabletoParticipatingHealthcareProviders.ParticipatingPlanagreesthatitwillprovideSLMCwithatleastthirty(30)daysnoticeofbenefitrevisionsaffectingreimbursementtoParticipatingHealthcareProviders.4.9TheParticipatingPlanshallberesponsiblefortheprintinganddistributionofidentificationcards,whichshallincludetheSLMCnameand/orlogo,toallCoveredIndividualsparticipatinginthishealthbenefitoption.ParticipatingPlanisobligatedtoprovideCoveredIndividualswithinformationand/ormaterialontheappropriateuseoftheidentificationcard.4.10TheParticipatingPlanagreestoexclusivelyusetheSLMCpreferredprovidernetworkintheStateofColorado.TheParticipatingPlanshallnotcontractdirectlywithanyPPO7VIPAR.R.EXIEAGLE.COUNTY/9.18.96bh6 00hospitalorotherhealthcareproviderintheStateofColoradowithoutSLMC’swrittenconsent.ARTICLEVINDEPENDENTRELATIONSHIP5.1Therelationshipofthepartiesheretoisonlythatofindependententitiescontractingwitheachotheratarm’slengthsolelyforthepurposeofaffectingtheprovisionsofthisParticipationAgreement.NoneofthepartiestothisParticipationAgreementnoranyoftheirrespectiveaffiliatesoremployeesshallbeconstruedtobeagents,employees,jointventurersorrepresentativesoftheother.5.2ParticipatingPlanshallnotinterferewithorotherwiseinfluencethemannerinwhichanyoftheservicesorobligationsofSLMCoutlinedinthisParticipationAgreementareprovided.SLMCshallnotinterferewithorotherwiseinfluencetherelationshipbetweenParticipatingPlananditsCoveredIndividuals.ParticipatingPlanacknowledgesthatSLMCdoesnotprovideprofessionalhealthcareservicestoCoveredIndividualsandthatParticipatingHealthcareProvidersareindividuallyandsolelyresponsiblefortheprofessionaldecisionsandactionsmadewhileprovidinghealthcareservicesandtreatmenttoCoveredIndividuals.ARTICLEVIINSURANCE6.1SLMCagreestomaintainatitsexpenseduringthetermofthisParticipationAgreementprofessionalliabilityinsuranceintheamountofonemillion($1,000,000)peroccurrencetoonemillion($1,000,000)aggregatetocoveranyclaimsthatcouldarisefromtheprovisionofservicesunderthisParticipationAgreement.Eachofthepartiesheretoshall,duringthetermofthisParticipationAgreement,maintainatitssolecostandexpenseallnecessaryinsuranceforitsemployees,includingbutnotlimitedtoworkers’compensation,unemploymentinsurance,andanyotherinsurancerequiredbylaw.Eitherpartywillprovidetheotherwithcertificationofsuchinsuranceuponrequest.ARTICLEVIIMEDICALRECORDS7.1SLMCshallrequireParticipatingHealthcareProviderstomaintainappropriatemedicalrecordsinsuchform,containingsuchinformation,andpreservedforsuchtimeperiod(s)asrequiredbystateandfederallawandSLMC.AllmedicalrecordsshallbeandremainPP0777/PAR.R.EX!EAGLE.COUNTY/9.18.96bh7 00*thepropertyofParticipatingHealthcareProvidersandshallnotberemovedortransferredfromthepremisesofParticipatingHealthcareProvidersexceptinaccordancewithapplicablelaw.7.2SLMCanditsParticipatingHealthcareProvidersshallonlyreleasemedicalrecordsofCoveredIndividualswithwrittenauthorizationforthereleaseofsuchrecordssignedbyCoveredIndividualoranotherpersonlegallyauthorizedtoconsenttothereleaseofCoveredIndividual’smedicalrecords.Whenpresentedwithanadequateauthorizationforthereleaseofmedicalrecords,SLMCanditsParticipatingHealthcareProvidersshallpermitParticipatingPlantoinspectCoveredIndividual’smedicalrecords,andshallprovidecopiesofsuchrecordstoParticipatingPlanuponreasonablerequest.ParticipatingPlanisresponsibletopayforcopiesofmedicalrecords,whetherrequestedbySLMCorParticipatingPlan,inaccordancewithratesestablishedbytheStateofColorado,DepartmentofHealth.7.3ThisParticipationAgreementdoesnotoblige$LMCtodisclosetoParticipatingPlaninternalSLMCrecords,documents,minutes,correspondenceoranyotherdocumentoritemrelatedtothecredentialingoforpeerreviewactivitiesorcommitteemeetingsrelatedtoanyparticularParticipatingHealthcareProvider.ParticipatingPlanisentitledtoreviewtheSLMCpoliciesandproceduresrelatinggenerallytocredentialingandpeerreview.ARTICLEVifiCONFIDENTIALITY8.1$LMCandParticipatingPlanshallholdandcausetheirrespectiveaffiliates,employees,andotherrepresentativesandagentstohold,instrictconfidence,ConfidentialInformationconcerningtheotherpartyorwithrespecttothisParticipationAgreementunlesscompelledtodisclosebyjudicialoradministrativeprocessorbyotherrequirementsoflaw.ForpurposesofthisParticipationAgreement,“ConfidentialInformation”shallmeanallinformationofaproprietaryorconfidentialnatureincludinganyfinancialinformationrelatingtoSLMCorParticipatingPlan,theirrespectiveaffiliates,employees,agentsorotherrepresentatives,orinformationotherwiseprohibitedfromtransmissionbycontractual,legalorfiduciaryobligations,includinganyinformationclearlymarkedasconfidential.ExhibitsAandBofthisParticipationAgreementshallbeconsideredConfidentialInformation.ConfidentialInformationshallnotincludeinformation(1)generallyavailabletothepublic,otherthanasaresultofadisclosurebythepartyreceivingsuchinformationonanon-confidentialbasisorfromasourccotherthanSLMCorParticipatingPlan.TheobligationscontainedinthisparagraphshallsurviveterminationofthisParticipationAgreementandcontinueforaperiodoffive(5)yearsthereafter.PP0777!PAR.R.EXJEAGLE.COUNTY/9.18.96bh8 CARTICLEIXPARTICIPATINGPROVIDERSLISTING9.1ParticipatingPlanmaylisteachParticipatingHealthcareProvider’sname,address(es),telephonenumber(s)andadescriptionofhis/herHealthcareServicesinParticipatingPlan’smarketing/promotionalactivitiestoCoveredIndividuals.However,suchdescriptionandlormaterialshallbesubjectto$LMCpriorwrittenapproval.ARTICLEXTERMOFPARTICIPATIONAGREEMENT10.1ThisParticipationAgreementshallcontinueforaperiodoftwelve(12)monthsanditshallberenewedforsuccessiveone-yearperiodseffectiveeachSeptember1stunlessterminatedassetforthinParagraphs10.2and10.3.10.2ThisParticipationAgreementmaybeterminatedatanytimebymutualconsentofbothparties.ThisParticipationAgreementmaybeterminatedwithoutcause,withorwithoutprovidingreasonsfortermination,byanyofthepartiesheretouponnotlessthansixty(60)dayspriorwrittennoticetotheotherparty.Anysuchwrittennoticeshalldesignatetheintendeddateoftermination.ThefeesoutlinedunderArticleIVshallremainineffectuntilthedesignateddateoftermination.10.3BreachofAgreement.ThefailureofapartytocorrectabreachofitsobligationsundertheParticipationAgreementwithinthirty(30)daysafterwrittennoticefromtheotherparty;however,thatifanysuchbreachbyapartycannot,withduediligence,becorrectedwithinsuchthirty(30)dayperiod,causeforterminationshallexistonlyifsuchpartyfailstoundertakeandtodiligentlypursuecorrectionofsaidbreachassoonasreasonablypossible.10.4TerminationshallhavenoeffectupontherightsandobligationsofthepartiesarisingoutofanytransactionsoccurringbetweenthepartiespriortotheeffectivedateofsuchterminationunlessotherwisespecificallystatedinthisParticipationAgreement.TerminationoftheParticipationAgreementshallnotaffectParticipatingPlan’sobligationtopayforCoveredServicesprovidedafterterminationoftheParticipationAgreementtoaCoveredIndividualwhowasproperlyadmittedtoHospital(s)orreceivedHealthcareServicesfromaParticipatingHealthcareProviderpriortosuchterminationprovidedCoveredIndividualwasotherwiseentitledtobenefitsofParticipatingPlan.PP0777!PAR.R.EXIEAGLE.COUNTY/9.18.96bh9 00ARTICLEXlARBifRATION11.1•Thepartiesheretoagreethat,anydispute,orclaimarisingoutoforrelatingtothemaking,performanceorinterpretationofthisParticipationAgreementshallberesolvedbyarbitrationconductedbytheJudicialArbiterGroup,Inc.,inDenver,ColoradooranyothermutuallyagreeabledisputeresolutionorganizationorentityinaccordancewiththeColoradoRulesofCivilProcedure.DisputesarisinginconnectionwiththisParticipationAgreementbetweenoramongothersnotpartiestothisParticipationAgreement,andanydisputesorclaimsconcerningmedicalmalpracticenegligenceorothertorts,shallnotbesubjecttoarbitration.ARTICLEXIIMISCELLANEOUSPROVISIONS12.1Notices.Anynoticerequiredtobegivenpursuanttothetermsandprovisionshereofshallbeinwritingandshallbepersonallydeliveredorsentbycertifiedmail,returnreceiptrequested,postageprepaid,orbygenerallyrecognizedovernightdeliveryserviceswhokeeprecordsofsuchdeliveries,tothefollowingaddresses:ParticipatingPlan:EagleCountyGovernment500BroadWay,P.O.Box479Eagle,CO81631SLMC:SloansLakeManagedCare,Inc.1355S.ColoradoBlvd.,Ste.902Denver,CO80222Attn:Contracts/Marketing12.2Assignment.NopartyshallassignorotherwisetransferthisParticipationAgreementoranyinteresthereinwithoutobtainingthepriorwrittenconsentoftheotherparty.12.3GoverningLaw.ThisParticipationAgreementshallbeconstruedandgovernedinallrespectsbythelawsoftheStateofColorado.12.4WaiversandAmendments.Notermorprovisionhereofshallbedeemedwaivedandnobreachexcused,unlesssuchwaiverorconsentshallbeinwritingandsignedbythepartyclaimingtohavewaivedorconsented.NowaiverofanyrightsunderthisParticipationAgreementbyanypartyshalloperateasawaiverofanyotherrights,orofthesamerightwithrespecttoanysubsequentoccasionforitsexercise.NowaiverbyanypartyofanybreachofthisParticipationAgreementshallbeheldtoconstituteawaiverofanyotherPPO7WPAR.R.EXIEAGLE.COUNTY/9.18.96bh10 CCbreachorcontinuationofthesamebreach.ThisParticipationAgreementmaynotbeamendedexceptinwritingsignedbyeachofthepartiestotheParticipationAgreement.12.5Headings.TheheadingsofthearticlesandparagraphsinthisParticipationAgreementareusedasamatterofconvenienceandforreferenceonly,andtheyinnowaydefme,limitordescribethescopeofthisParticipationAgreementortheintentofanyofitsprovisions.12.6Severability.ifanytermorprovisionofthisParticipationAgreementshall,toanyextent,beheldinvalidorunenforceable,theremainderofthisParticipationAgreementshallnotbeaffected.Suchremainingportionshallbevalid,enforceableandoffullforceandeffect.12.7ThirdPartyBeneficiary.ThepartiestothisParticipationAgreementdonotintendtocreateorconferanybenefitsunderthisParticipationAgreementtoanyotherpersonorlegalentityotherthantheparties.TherightsandobligationsofeachpartytothisParticipationAgreementshallinuresolelytothebenefitofthepartieshereto,andnopersonorentity,includinganyCoveredIndividualorParticipatingHealthcareProvider,shallbeconsideredathirdpartybeneficiaryofthisParticipationAgreement.12.8TradeName.TradeMarkandCopyright.NothingcontainedinthisParticipationAgreementshallconferuponeitherpartyalicensetouseorownershipof:(1)thenameoftheotherpartyoranyothernameunderwhichapartyoperates,or(ii)anytrademark,servicemarkortradenameownedbysuchparty.UponterminationofthisParticipationAgreement,alluseofnames,trademarks,servicemarksortradenamesownedbyonepartyasdescribedabovebytheotherpartyshallcease,exceptasmaybeotherwiseexpresslyauthorizedinwriting.EachofthepartiestothisParticipationAgreementwarrantthatneitherthisParticipationAgreementnorthetangibleorintangibleproductsproducedasaresultofitwillinfringeuponorviolateanypatent,copyright,tradesecretorotherproprietaryrightofanythirdparty,andeachpartywillindemnifyandholdtheotherharmlessfromandagainstanyloss,cost,liabilityorexpense(including,reasonableattorneyfees)arisingoutofanybreach,orclaimedbreachofthiswarranty.12.9LegalAction.IntheeventoflegalactionbyapersonnotapartytothisParticipationAgreementagainstapartytothisParticipationAgreement,relatedtotheobligationsorperformanceoutlinedherein,theotherpartyshallcooperatetotheextentthatnoconflictofinterestexistsbetweentheparties.Suchcooperationmayincludeprovidingappropriateindividualsfordepositionsand/ortestimonyincourt.12.10AdvertisingRestraints.Eachpartyagreesthat,withouttheotherparty’swrittenconsent,itwillnotusethename,servicemarks,ortrademarksoftheotherpartyorofanyofitsaffiliatedcompaniesorrevealtheexistenceofthisParticipationAgreementorPP0777!PAR.R.EXIEAGLE.COUNTY/9.18.96bh11 00thetermsorconditionsthereofinanywrittenadvertising,publicityrelease,orsalesrepresentation.Acknowledgment.EachpartyacknowledgesthatithasreadthisParticipationAgreement,understandsitandagreestobeboundbyitstermsandfurtheragreesthatitisthecompleteandexclusivestatementoftheParticipationAgreementbetweentheparties,andsupersedesallproposals,oralorwrittenandallothercommunicationsbetweenSLMCandParticipatingPlanrelatingtothesubjectmatterofthisParticipationAgreement.12.12Counterparts.ThisParticipationAgreementmaybeexecutedinoneormorecounterparts,eachofwhichshallbedeemedanoriginalandallofwhichtogetherconstituteoneandthesameinstrument,notwithstandingthatallofthepartiesarenotsignatorytoanyonecounterpart.NWITNESSWhEREOF,theundersignedhaveexecutedthisParticipationAgreementasofthedayandyearfirstwrittenabove.SloansLakeManagedCare,Inc.BYTITLE:an/,GveWssDevelopmentEagleCountyGovernmentBY:rlTITLE:/DATE:‘N-—7_::‘BY:TITLE:DATE:BY:jZ4(ZJI12ReturnOri.ToPP0777!PAR.R.EXIEAGLE.COUNTY!9.18.96bh12.11DATh:TITLE:________________DATE: ANTCTHISAIvIENDMENTiseffectivethe15tdayofSeptember,1997,byandbetweenEagleCountyGovernment(herein‘ParticipatingPlan”)andSloansLakeManagedCare,Inc.,aColoradocorporation(herein“SLMC’).‘WHEREAS,ParticipatingPlanandSLMChaveenteredintoaexclusiveparticipationagreementdatedthedayofSeptember,1996,(herein“ParticipationAgreement”),wherebyParticipatingPlancanprovideapreferredprovideroptionforindividualsenrolledinthehealthbenefitplansofferedbyParticipatingPlan,andWHEREAS,ParticipatingPlanandSLMCdesiretoamendtheParticipationAgreementasfollows:1.ExhibitsB-ithroughB-12andallupdatestoExhibitsB-ithroughB-12receivedafterSeptember1.1996,shallbeamendedtoread“ExhibitB”.2.ARTICLEI,DEFINITIONS,Paragraph1.12shallbeamendedwhichshallread:1.12.“RepriceorRepricing”meanstherecalculationofclaimbasedontheratesoutlinedinExhibitsAandB.3.ARTICLEII,NETWORKMANAGEMENT,Paragraph2..9shallbeamendedtoread:2.9SLMCagreestoRepriceallParticipatingHealthcareProviderclaimsandattachaRepricingcoversheettotheclaimaspartoftheRepricingfeeunderArticleIV,Paragraph4.1.RepricingincludesclaimreviewonclaimsfromParticipatingHealthcareProvidersreimbursedaccordingtoExhibitsBformultiplesurgeries,RNEandBRcptcodes,andunlistedproceduresintheSt.AnthonyPublishingRelativeValueforPhysicians(RVP).4ARTICLEIV,PARTICIPATINGPLAN’SOBLIGATIONS,Paragraph4.1shallbeamendedtoread:4.1TheParticipatingPlanagreestopayanaccessfeeoftwodollarsandforty-sevencents($2.47)peremployeepermonthandaRepricingfeeofseventy-fivecents($.75)peremployeepermonth.SuchfeesshallbebasedonthenumberofemployeescoveredunderthisParticipationAgreementonthefirstdayofeachmonthandduenolaterthanthelastdayofthemonth.ParticipatingPlanshallprovideSLMCwithastatementlistingthenumberofemployeescoveredunderthisParticipationAgreementnolaterthanforty-five(45)daysfollowingtheexecutionofthisParticipationAgreementand,thereafteronamonthlybasis.Thisstatementshallaccompanyeachpaymentoftheaccessfee.ParticipatingPlanshallremitthefeesdirectlytoSloansLakeManagedCareat:SloansLakeManagedCare,Inc.1355SouthColoradoBlvd.,Ste.902Denver,CO80222Attn:FinanceDept.ADD7O/PAR-EX-Rieaglecounty/8.26.97/DM-H CC’NOWTHEREFORE,1.ThisAmendmentshallbeattachedtoandincorporatedintothetermsoftheParticipationAgreement.ParticipatingPlanhasreviewedandagreestobeboundtothetermsandconditionsoftheAmendment,whichisattachedtoandspecificallyincorporatedintothisAmendment.2.ExceptasamendedbythisAmendment,thetermsandprovisionsofthisParticipationAgreementshallremaininfullforceandeffect.WHEREOF,thepartieshaveexecutedandenteredintothisAmendmentasofthedayandyearfirstsetforthabove.ExecutedbyEagleCountyGovernment,thisdayof1997.ExecutedbySlLakeManagedCare,mc.,this____dayof,19By:_____Title.DISTRIBUTIONQitinaIsto:1.ContractBook2._____________________3.______________________4.________________Qpiesto:1.Accounting2.____________________4.________________ADD7O/PAR-EX-Rleaglecounty/S.26.97/DM-H
