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2021-074B
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Last modified
6/22/2021 12:13:29 PM
Creation date
6/11/2021 3:23:37 PM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
05/11/2021
Control Number
2021-074B
Agenda Item Number
12.D.1.
Entity Name
Employer Direct Healthcare, LLC
Subject
Surgeryplus Services Agreement
Addition of SurgeryPlus Benefit as Optional Benefit
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R <br />DocuSign Envelope ID: 29EAB906-1936-4BAB-83BE-97C974F00293 <br />S_URGERYPLUS SERVICES AGREEMENT <br />This SURGERYPLUS SERVICES AGREEMENT (this "Agreement") is made effective as of July 1, 2021 (the <br />"Effective Date") by and between Employer Direct Healthcare, LLC, a Delaware limited liability company with <br />its principal place of business located at 2100 Ross Avenue, Suite 550, Dallas, Texas 75201 ("EDH") and Indian <br />River County, Florida, a political subdivision of the State of Florida with its principal place of business located <br />at 1801 27th Street, Vero Beach, FL, 32960("Sponsor"). EDH and Sponsor are referred to collectively as the <br />"Parties" and individually as a "Party." <br />RECITALS <br />I. Sponsor desires to make available to its employees, their dependents, and other eligible beneficiaries <br />appropriate medical, hospital and other health care services through Sponsor's self-funded health <br />benefits plan(s) (collectively referred to herein as the "Plan"). <br />II. Sponsor exercises discretionary authority and control respecting management of the Plan. <br />III. EDH has contracted with physicians, other licensed health care practitioners, hospitals, and healthcare <br />facilities (collectively, the "Networlr") who or which have agreed to provide certain health care services <br />consistent with the rates and terms negotiated by EDH. <br />IV. EDH, as part of its network offering, provides individuals enrolled in self-funded health benefits plans <br />which utilize the Network with certain administrative, settlement, case management, travel, and <br />logistics services related to such individuals' medical procedures. <br />V. EDH provides self-funded health benefits plans with access to the Network through its branded <br />offering known as SurgeryPlus. <br />VI. Sponsor desires to offer SurgeryPlus to Participants (as defined below) under the Plan. <br />NOW THEREFORE, in consideration of the promises and mutual covenants contained herein, the <br />Parties agree as follows: <br />ARTICLE 1. <br />DEFINITIONS <br />The following terms shall have the following meanings in this Agreement (such meanings to be equally <br />applicable to both the singular and plural forms of the terms defined): <br />"Business Associate Agreement" has the meaning set forth in Section 6.4 of this Agreement. <br />"Claim" has the meaning set forth is Section 4.3(a) of this Agreement. <br />"Case Rate" means the sum of all allowed charges for Medically Necessary Services provided during <br />or in relation to an Episode of Care (inclusive of all.technical, professional, facility, and other medical services) <br />billed by Providers. Covered Services included in a Case Rate commonly include, but are not limited to: (a) the <br />Medically Necessary Services rendered by a Provider during an Episode of Care (b) equipment used by a <br />hospital or facility; (c) in-hospital or in -facility medications or biologics and supplies; (d) implants; (e) laboratory <br />testing and services; (f) in-hospital meals; (g) hospital confinement days; (h) in-hospital or in -facility nursing <br />care; (i) in-hospital physical therapy; and 0) post -discharge follow-up consultations occurring within the <br />applicable global period defined by the Centers for Medicare & Medicaid Services ("CMS"). Services commonly <br />excluded from a Case Rate include, but are not limited to: (1) medical consultations and certain diagnostic <br />testing provided In advance of a medical procedure to determine whether or not such procedure is a Medically <br />-1- <br />
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