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DocuSign Fnvelope ID: 5B185859-5943-4C41-90BF-OCE5E9OFDADD (01/2021 Version) EXHIBIT A CLIENT APPLICATION October 1, 2021 [IMPORTANT — PLEASE READ CAREFULLY: Client should complete Section A and carefully review this Exhibit A. which has been completed by Administrator, in order to ensure the accuracy and completeness of such information. Client shall promptly notify Administrator of any inaccuracy or omission with respect to such terms and conditions, if applicable (including, without limitation, the Client Information in Section A).] A. INFORMATION ABOUT CLIENT Client's Name: Indian River County Board of County Commissioners Client's Mail Address: 1801 27th Street, Vero Beach, Florida 32960-3365 B. PLAN DESIGN; MEMBER COST SHARE Member Cost Share: Please see current Summary of Benefits. Client represents and warrants that the design of Client's Plan as reflected in a Plan design document for Client ("PDD"), accurately reflects the applicable terms of Client's Plan for purposes of this Agreement. Client shall provide Administrator with ninety (90) days prior written notice of any proposed changes to the design of Client's Plan (including the PDD), which changes shall be consistent with the scope and nature of the services to be provided by Administrator under this Agreement. Client agrees that it is responsible for Losses resulting from (a) any failure to implement Plan design changes which are not communicated in writing to Administrator, or (b) implementation of verbal or written direction regarding exception or overrides to the PDD. In addition, Client shall notify Members of any Plan design changes prior to the effective date of any such changes as required by applicable law. C. SERVICES: FORMULARY. 1. Base Administrative Services: The following services are the base administrative services made available to Client and its Members pursuant to the Agreement (including this Exhibit A) (the "Base Administrative Services'), as applicable: • Administration of eligibility submitted via tape or telecommunication • Eligibility maintenance • Client support system for on-line access to current eligibility • Administration of Client's Plan Design • In -network claims adjudication via on-line claims adjudication system • Designated Account Team • Client clinical and plan consulting, analysis and cost projections • Annual analysis of program utilization and impact of plan design and managed care interventions • Welcome Package and ID Cards for new Members • Standard Member communications • Toll-free telephone access to customer service for the program for use by Members and Client's benefits personnel and representatives NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY AND CONSTITUTES TRADE SECRETS OF EXPRESS SCRIPTS AND RXBENEFITS