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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />J.R. SMITH, CLERK <br />EXPEDITED REIMBURSEMENT AGREEMENT <br />August 15, 2022 <br />Indian River County Board of County Commissioners <br />Upon receipt of your signature below, Optum agrees to expedite reimbursement of a <br />potential Specific claim prior to adjudication by the Administrator under the following <br />conditions: <br />1) Client submits a request, including claimant name and amount of <br />reimbursement being requested, for a potential claim accompanied by a <br />Blue Cross/Blue Shield, Aetna, Cigna report(s) and/or PBM report <br />outlining the paid and/or pending claims included in the request. <br />2) Covered Expenses exceed the Specific Deductible by $10,000 or greater <br />initially, and $5,000 or greater for subsequent expenses. <br />3) Administrator and/or the Client will provide complete and detailed <br />information regarding the potential claim to Optum by the end of the <br />following month in which the reimbursement request is made. <br />4) If Optum determines the claim is not eligible under the Specific Excess <br />Loss Insurance, the Client understands and agrees that Optum will offset <br />the amount reimbursed against future claims. In the event there are no <br />future claims, the Client agrees to repay the expenses reimbursed within <br />30 days of Optum's request. <br />5) This agreement may be termirliated at any time by Optum upon written <br />notice. • oJ`�;�y:c ... s!o,��9s .. <br />Signature of Authorized Per n <br />.=?oi• � .•off;.;• <br />Peter D. O'Bryan cOU�s�Vtle. Chairman <br />Printed Name <br />September 13, 2022 <br />Date <br />4 + <br />A, A- L <br />,lr <br />Attest: Jeffrey R. Smith, Clerk of <br />Cir Court and Comptroller <br />r t <br />Br. h /) Af 01C) Ll NTY A [70 R Z4 E";' <br />Deputy Clerk <br />