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Optum <br />EASY REPORTING AGREEMENT <br />August 15, 2022 <br />Indian River County Board of County Commissioners <br />Upon receipt of your signature below, Optum will implement Easy Reporting for potential <br />Specific claims. The following will apply: <br />Optum will identify claims for reimbursement as a courtesy based on detailed paid claim <br />reports submitted by the Administrator(s) and/or PBM(s). Please note that responsibility for <br />identifying and submitting claims remains the Client's responsibility. <br />Optum will reach out to the designated stop loss contact(s) on file, if necessary, to obtain <br />additional information, including, but not limited to: <br />- Eligibility documentation, work status, COBRA <br />- Other insurance coverage <br />- Accident details/subrogation <br />- Any other information deemed necessary in order to fully adjudicate the stop loss claim <br />Claim submissions whether identified by the Administrator(s), the Client, the Broker or <br />Optum will be subject to the timely filing provision as outlined in the stop loss policy. All <br />claim submissions/paid claim reports must be submitted within 12 months after the end of <br />the Benefit Period in order to be eligible for reimbursement under the stop loss policy <br />This agreement may be terminated 9OWW"01 Optum upon written notice. <br />w J : 5Q <br />Signature of Authorized Pers?o'.. Q: <br />Peter D. O'Bryan ••4y9��'FR GOU��� oa <br />•"7itle: <br />Printed Name <br />September 13, 2022 <br />Chairman <br />Date APPpokl=-t) .A'1 'TP9 FORM <br />A:E�t L.:,: -.AL S..:FE-ICIENCY <br />Attest: Jeffrey <br />R. Smith, Clerk of B <br />Circuit Court and Comptroller z 3`i i_;3.�! 1E1Ni�CJi_C� <br />O OUN•TY Ai'T0RNEY <br />Br.. ok <br />Deputy Ciark <br />