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EXHIBIT 3— DISCLOSURE OF PROTECTED HEALTH INFORMATION <br />FOR PLAN ADMINISTRATION <br />BlueCross and BlueShield of Florida, Inc. and Indian River County <br />Group Health Plan ("GHP") must promptly notify BCBSF in writing if any of the information contained in EXHIBIT <br />3 changes. <br />PART I <br />Name(s) and Title(s) of Employer representatives (i.e. employees of Employer) authorized to request and receive <br />the minimum necessary Protected Health Information from Administrator: <br />Suzanne Boyll, HR Director <br />Shelia O'Sullivan, HR Generalist <br />Ed Halsey, Internal Audit <br />Raeanne Cone, Assistant Chief Deputy Comptroller <br />Marcela Pacheco-Hoel, Benefits Administrator <br />Elissa Nagy, Chief Deputy Comptroller <br />Suzann Minuse, Payroll Coordinator <br />Kristen Daniels, Director of Management and Budget <br />for the performance of the following plan administration functions for GHP unless otherwise indicated by GHP: <br />• Actuarial and statistical analysis <br />• Claims/membership inquiries <br />• Procurement of reinsurance or stop loss coverage <br />• Quality assessment and improvement activities <br />• Performance monitoring <br />• Other health care operations <br />• Payment activities <br />PART II <br />Identify the name(s), title(s) and company name(s) of any individual(s) from organizations other than Employer <br />or Group Health Plan ("GHP") (examples of such "GHP Vendor" types of services include, but are not limited to, <br />stop -loss carriers; reinsurers; agents, brokers or consultants; or external auditors) that Employer or GHP hereby <br />authorizes to request and receive the minimum necessary Protected Health Information to perform plan <br />administration functions and/or assist with the procurement of reinsurance or stop -loss coverage: <br />Company Name <br />Type of Service Performed <br />(Example: stop -loss carrier, <br />reinsurer, agent, broker <br />Name of Individual Performing <br />Service <br />Title of Individual Performing <br />Service <br />Lockton <br />Broker <br />Emily Jackson <br />Account Executive <br />Lockton <br />Broker <br />Amanda Ismaili <br />Account Manager <br />Lockton <br />Broker <br />Cassidy Buck <br />Account Analyst <br />Lockton <br />Broker <br />Rachel Hargrove <br />Senior Account Executive, Clinical Consultant <br />Lockton <br />Broker <br />Elizabeth Kri as <br />Account Executive, Clinical Consultant <br />Lockton <br />Broker <br />Carolyn Micali <br />Health Risk Solution Consultant <br />Lockton <br />Broker <br />Tressa Chretien <br />Pharmacy Benefits Consultant <br />Lockton <br />Broker <br />Dennis Dulaney <br />VP, Actuary <br />Lockton <br />Broker <br />SL Reporting <br />stoplossreporting@lockton.com <br />Lockton <br />Broker <br />SL Support <br />stoploss@lockton.com <br />Lockton <br />Broker <br />Jonathan Bruemmer <br />Senior Claims Analyst(stop loss <br />Infolock <br />Data/Analytics Vendor <br />om data@Sciohealthanalytics.c <br />Analytical Mailbox <br />Infolock <br />Data/Analytics Vendor <br />infolock@lockton.com <br />Analytical Mailbox <br />Infolock <br />Data/Analytics Vendor <br />Courtney Hutton <br />Data Coordinator <br />Rx Benefits <br />PBM Consultant <br />Donna Buzhardt <br />Account Executive <br />Rx Benefits <br />PBM Consultant <br />Latanya Edwards <br />Account Manager <br />