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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 terminated at any time by Optum upon written <br />notice.t-e4t '-b <br />•*,, <br />Signature of Authorized Peran ;qQ <br />-�o�• � .•oma;' <br />Peter D. O'Bryan •syOrwha @: Chairman <br />C Q-lu <br />Printed Name <br />September 13, 2022 <br />Date <br />'ro FORML <br />Attest: Jeffrey R. Smith, Clerk of <br />Circyil, Court and Comptroller 6`:'Dyk <br />- -'- <br />i COt.�[�TY;'l-TOR€ar=S' <br />Deputy Clerk <br />