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DocuSign Envelope ID: 29EAB906-1936-4BAB-83BE-97C974F00293 <br />Necessary Service; (b) Convenience Items; and (c) any medical procedure or medical care that is not a Medically <br />Necessary Service. <br />4.2 Particibant Scheduling. Upon acceptance of a Participant by a Provider, EDH will verify the <br />Participant's eligibility under the Plan to receive Covered Services. EDN will also coordinate and schedule <br />Covered Services to be provided in connection with the anticipated Episode of Care among the Participant, the <br />Provider(s) and, if applicable, any vendors of Travel Services, consistent with the Plan requirements mutually <br />agreed by the Parties in writing. <br />4.3 Pricing. <br />(a) Claims. Sponsor shall pay EDH the aggregate sum of all claims, fees, costs, expenses <br />or other charges relating to an Episode of Care or potential Episode of Care (including, without limitation, <br />emergency or urgent Medically Necessary Services rendered during but unrelated to an Episode of Care as <br />described in Section 4.7) which are submitted to EDH by Providers, vendors of Travel Services, consistent with <br />the Plan requirements mutually agreed by the Parties in writing, or any other provider of goods or services <br />related to an Episode of Care or potential Episode of Care (each such claim, fee, cost, expense, or charge, a <br />"Claim" and collectively, "Claims"), with the exception of those Claims subject to good faith dispute by Sponsor. <br />Any Claim related to Medically Necessary Services rendered by a Provider shall be charged by EDH and paid by <br />Sponsor according to the bundled rates or other pricing terms independently agreed to by EDH and the <br />Provider. EDH shall invoice, and Sponsor shall pay, Claims in accordance with Section 4.5. <br />(b) EDH Fees. In addition to payment for Claims, each month, Sponsor shall pay to EDH <br />a fee equal to Four Dollars ($4.00) per eligible Employee of Sponsor (the "Network Use fee"). During the first <br />year of the Term, Sponsor shall receive a discount on the Network Use Fee. Accordingly, during the first year <br />of the Term only, the Network Use Fee shall be Three Dollars ($3.00) per eligible Employee of Sponsor. <br />Additionally, each month, Sponsor shall pay EDH a fee for EDH's educational and promotional communications <br />services equal to Twenty -Five Cents ($0.25) per eligible Employee of Sponsor (the "Communications Fee"). For <br />clarity, the Communications Fee only covers those educational and promotional communications materials <br />described in Section 3.4 of this Agreement. If Sponsor requests that EDH create or distribute educational and <br />promotional communications materials in addition to those described in Section 3.4. Sponsor shall pay all <br />reasonable costs and expenses actually incurred by EDH related to such request. The Network Use Fee and <br />the Communications Fee shall be collectively referred to as the "EDH Fees." The EDH Fees shall be calculated <br />each month based on the monthly weighted average of eligible Employees of Sponsor according to the <br />Sponsor -provided eligibility files of the prior month. During any period in which Sponsor (or it's designee) fails <br />to provide EDH with weekly eligibility files in accordance with Section 3.5, the EDH Fees shall be calculated <br />based upon the number of eligible Employees of Sponsor in the most recent eligibility file received by EDH <br />which complies with the terms of Section 3.5; provided, however, upon EDH's receipt of complete and accurate <br />eligibility files for any such period of deficient eligibility file production, the EDH Fees for such period shall be <br />recalculated by EDH, and Sponsor shall remain obligated to pay EDH the amount of any underbilled EDH Fees <br />relating to such period. EDH shall invoice, and Sponsor shall pay, EDH Fees in accordance with Section 4.5. <br />(c) Amendments to Plan. As of the Effective Date, the Plan Documents do not include <br />any Plan Carveout. If at any time during the term of this Agreement the Plan Documents are amended to <br />incorporate a Plan Carveout, then, during the period in which any such Plan Carveout is effective, the Network <br />Use Fee specified in Section 4.3(b)'shall be calculated as follows: Sponsor shall pay to EDH a fee equal to thirty- <br />five percent (35%) of the aggregate sum of all Claims for that month. <br />4.4 EDH Savings Guarantee. <br />(a) EDH Savings and Total Network Use Fee. Within sixty (60) days from the date of EDH's <br />receipt of all Claims relating to Covered Services or Network Services administered or provided during the Term <br />9 � <br />
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