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DocuSign Envelope ID: 29EAB906-1936-4BAB-83BE-97C974F00293 Necessary Service; (2) Convenience Items; (3) Travel Services; and (4) any medical procedure or medical care that is not a Medically Necessary Service. "Communications Fee" has the meaning set forth in Section 4.3,(b) of this Agreement. "Comparable Case Rate" means, with respect to any Episode of Care, the total amount reasonably determined by EDH to be the sum of all allowed charges for Medically Necessary Services provided during or in relation to such Episode of Care (inclusive of all technical, professional, facility, and other medical services) if such Medically Necessary Services were provided by health care providers outside of the Network. In determining any Comparable Case Rate, EDH may take into account: (a) Sponsor's actual historical bundled case rates and/or claims data; and/or (b) EDH's observed historical average bundled case rates and claims data. In any event, EDH's determination of any Comparable Case Rate will take into consideration all applicable procedure codes, geography, and procedure setting (i.e., inpatient vs. outpatient). "Convenience Item" means a service, supply, or other item provided by a Provider during an Episode of Care which is not a Medically Necessary Service. Convenience Items include, without limitation, telephone use, premium television access, and guest meals. A Participant shall have sole financial responsibility for any Convenience Item utilized during such Participant's Episode of Care. "Covered Service" means any Medically Necessary Service offered by a Provider for which EDH has contracted bundled rates or other reimbursement rates or pricing terms. "Diagnosis Case Code" means the diagnosis code(s) (including, without limitation, the applicable ICD - 10 -CM codes) used by a Provider to identify the anticipated items and services to be provided to a Participant during an Episode of Care. "EDH Fees" has the meaning set forth in Section 4.3(b) of this Agreement. "EDH Savings" has the meaning set forth in Section 4.4(a) of this Agreement. "Employee" means only those Participants who are employees of Sponsor (including those employees receiving Plan benefits through COBRA) or retirees eligible to receive benefits under the Plan. Employee excludes all dependents or other Participants enrolled for coverage in the Plan. "Episode of Care" means the period of time initiated on the first day a Participant receives Covered Services in an inpatient, outpatient, surgery center, in -office, or other health care facility setting from a Provider related to the applicable Diagnosis Case Code and ends when such Participant is discharged from the applicable health care facility. "ERISA" means the Federal Employee Retirement Income Security Act of 1974, as amended from time to time, and the regulations and other guidance issued thereunder. "HIPAA" means the Health Insurance Portability and Accountability Act of 1996, including the Administrative Simplification provisions of HIPAA Title II, Subtitle F, the implementing regulations at 45 C.F.R. Parts 160-164, and the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act of 2009 ("HITECH"), and the regulations promulgated thereunder, all as amended from time to time. "Initial Term" has the meaning set forth in Section 5.1 of this Agreement. "Invoice" has the meaning set forth in Section 4.5 of this Agreement. -2- r