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This Contract shall begin on the Effective Date and shall continue until December 31, 2015. The Parties also agree that the BOR will have five (5) options to renew this Contract for an additional term of up to one (1) calendar year each, which shall begin on January 1 and end at midnight on December 31, each renewal term upon the same terms, conditions, and at the price in effect at the time of the renewal as shown on Attachment A hereto. The renewal option shall be exercisable solely and exclusively by the BOR. As to each term, the Contract shall be terminated absolutely at the close of the then current calendar year without further obligation by the BOR except that the BOR will provide payment for services provided up to the date of termination.
PAYMENT FOR SERVICES
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Fees. The BOR shall pay Contractor for the contracted services monthly based on the fees set forth in Attachment A, Premiums and Fees specifically incorporated by this reference. The fees shall be fixed for the term(s) indicated, and any special services provided in addition to those referenced on Attachment A, Premiums and Fees are not billable to the BOR without the prior written consent of the BOR. Each invoice for payment must reference this Contract Number, show Contractor’s tax identification number, and be itemized to identify the activities being billed and all Deliverables during the time period of the invoice. The BOR will pay the invoice within thirty (30) Calendar Days of receipt, as adjusted to reflect payment offsets, and payment delays permitted under this Contract. All invoices shall be sent in the form and to the address designated by the BOR to Contractor in writing.
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Premiums. The BOR shall pay Contractor MSA INO Plan premiums in the amount set forth in Attachment A, Premiums and Fees and the fee for administering the Stand-Alone HRAs as set forth in Attachment A, Premiums and Fees. Each invoice for payment must reference this Contract Number, show Contractor’s tax identification number, and be itemized to identify the activities being billed and all Deliverables during the time period of the invoice. The BOR will pay the invoice within thirty (30) Calendar Days of receipt, as adjusted to reflect payment offsets, and payment delays permitted under this Contract. All invoices shall be sent in the form and to the address designated by the BOR to Contractor in writing.
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Rejection of Services. If the BOR rejects Contractor’s performance of Administrative Services or Deliverables, Contractor shall promptly re-perform these Services or Deliverables to remedy any deficiencies at no additional cost to the BOR and resubmit to the BOR for approval in accordance with the process described in Section 24, Unsatisfactory Performance and Damages.
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Prompt Payment. Contractor shall comply with O.C.G.A. § 33-24-59.5 with regard to the prompt payment of claims for healthcare services provided pursuant to this Contract.
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Maximum Funds. The total of all payments made by the BOR to Contractor under this Contract shall not exceed the premiums and other fees set forth in Attachment A, Premiums and Fees to this Contract (the “Maximum Funds”), which have been provided for through the use of State or other designated funds. The BOR has no responsibility for payment beyond that amount. It is expressly understood that the total amount of payment to Contractor will not exceed the Maximum Funds provided above, unless Contractor has obtained prior written approval, in the form of an amendment to this Contract, authorizing an increase in the total payment.
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No Additional Compensation. Contractor’s employees, designees, or assignees shall not be entitled to, nor shall it receive any additional consideration, compensation, salary, wages, or any other type of remuneration for services rendered under this Contract, except as specifically permitted herein. In particular, Contractor will not be entitled by virtue of this Contract to consideration in the form of overtime, health insurance benefits, retirement benefits, disability benefits, disability retirement benefits, sick leave, vacation time, paid holidays, or other paid leaves of absence of any type or kind whatsoever.
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Member Liability. Contractor ensures that Network Providers agree that the only charges for which a Member may be liable and billed directly by Network Provider shall be the charges for services that are Non-Covered Services and the Co-Payments, Co-Insurance and Deductibles set forth in the applicable MSA INO Plan. Under no circumstances shall Contractor or Network Providers bill any Member for the difference between billed charges and the applicable network fee schedule for the provision of Covered Services under this Contract. Whenever any such charge has occurred, the Network Provider will refund such charge to the Member within fifteen (15) Calendar Days of discovering, or receiving notification of, the charge. If the BOR receives notice of any such charge, the BOR shall inform Contractor and Contractor shall address such breach with the Network Provider in accordance with its then current contract with the Network Provider. The obligations set forth in this section will survive the termination or expiration of this Contract regardless of the cause giving rise to the termination or expiration, and will be construed for the benefit of Members.
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Hold Harmless. Contractor shall ensure that the Network Provider shall hold each Member harmless from the cost of Covered Services that have been determined not to be Medically Necessary or to have been rendered in a manner not in accordance with and appropriate under the standards and requirements of Contractor. Notwithstanding this provision, if the Member or the Member’s legal representative requests Network Provider to provide services, after being informed by Network Provider that Covered Services have been determined by a Plan not to be Medically Necessary or that such services will be rendered in a manner not in accordance with and appropriate under the applicable standards and requirements, Network Provider shall be permitted to collect from the Member its usual and customary charges for providing such services. Network Provider may bill a Member for Non-Covered Services if Network Provider has obtained the written consent of the Member prior to rendering such services.
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