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EXHIBIT 10.87
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THIRD AMENDMENT TO THE UTILIZATION REVIEW AGREEMENT
DATED JANUARY 1, 1989, AS AMENDED
BETWEEN
HEALTHCARE COMPARE CORP.
AND
NATIONAL ASSOCIATION OF LETTER CARRIERS
HEALTH BENEFIT PLAN
THIS AGREEMENT is entered as of this 31st day of December 1991, between
HealthCare COMPARE Corp. (hereinafter called "COMPARE"), and National
Association of Letter Carriers Health Benefit Plan (hereinafter called
"CARRIER").
WITNESSETH
WHEREAS, COMPARE AND CARRIER have heretofore entered into a certain UTILIZATION
REVIEW AGREEMENT, dated January 1, 1989, and amended on November 1, 1989, and
January 1, 1991, which provides for utilization review services to be rendered
to CARRIER,
WHEREAS, COMPARE and CARRIER desire to amend the Utilization Review Agreement
in the manner set out herein.
NOW, THEREFORE, in consideration of the mutual covenants and agreements set out
herein, one dollar and other good and valuable consideration, receipt of which
is hereby acknowledged, the parties hereto agree as follows:
A. Paragraph 12.A. of the Utilization Review Agreement shall be deleted in
its entirety and replaced by the following:
A. The term of this Agreement shall be for one (1) year, beginning
January 1, 1989, and ending December 31, 1989, and shall automatically
renew for consecutive one (1) year terms thereafter, unless terminated
as hereinafter set forth, conditioned upon OPM approval of the terms of
this Agreement.
B. Effective January 1, 1992, Section 4.B (FEES AND SERVICES) shall be
deleted in its entirety and replaced with the following:
B. The "base fee" set out in the Schedule of Fees is for the first
year of this Agreement. For each year after the first year of the
term (the "Renewal Year"), COMPARE shall have the right to
increase the fee charged CARRIER. Such base fee for Hospital Review
Services shall not, without the specific written approval of
CARRIER, be increased over the base fee by more than the lower of,
i) the percentage of increase by which the Consumer Price Index
("CPIU") on December 31 of the last preceding year exceeded the CPI
from December 31, 1988, or, ii) the annual CPI increase allowed by
OPM in establishing the administrative expense ceiling for the
CARRIER applicable to the Renewal Year ("OPM-CPI"). For the purposes
of Subsection (i), the term "Consumer Price Index" means the
consumer price Index - U.S. City averages for Urban Wage Earners and
Clerical Workers, All Items, of the United States Bureau of Labor
Statistics
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(1982-1984=100). The Consumer Price Index for any year shall be determined
by averaging the monthly All Items Indices for that year. If the manner in
which such Consumer Price Index as determined by the Bureau of Labor
Statistics shall be substantially revised, an adjustment shall be made in
such revised index which, would produce results equivalent, as nearly as
possible, to those which would have been obtained if the Consumer Price
Index has not been so revised. If the 1982-1984 average shall no longer be
used as an index of 100, such change shall constitute a substantial
revision.
For the purposes of Subsection (ii), CARRIER shall notify COMPARE of the
average of the monthly OPM-CPI between October 1 and September 30 no later
than October 31 of each year. COMPARE shall prepare and deliver to
CARRIER a Schedule of Fees for the upcoming year based on the OPM-CPI. The
Schedule of Fees shall be sent to CARRIER within thirty (30) days of
receipt of OPM's estimate. Provided, however, in January of the year for
which the price increase is effective, COMPARE will determine whether the
CPIU was less than the OPM-CPI, in which case a revised Schedule of Fees
will be promptly provided to CARRIER.
CARRIER shall provide COMPARE with a summary document of OPM's advice of
the actual CPI percentage promptly upon their becoming aware of it.
CARRIER and COMPARE agree to adjust Hospital Review Fees paid as
set out above. Such adjustment and reconciliation will be completed within
thirty (30) days of receipt of OPM's actual annual percentage increase,
and COMPARE shall pay CARRIER or CARRIER shall pay COMPARE monies due
within thirty (30) days of completion of the adjustment.
C. Effective January 1, 1992, the revised Schedule of Fees, attached hereto
and made a part hereof, shall replace and supersede all previous
Schedules of Fees.
D. Parties hereby ratify and affirm the Utilization Review Agreement and agree
that it is in full force and effect and valid except as amended herein.
This Amendment shall prevail over any conflict with the Utilization Review
Agreement. In all respects the Utilization Review Agreement shall be
construed and interpreted to include all of the terms of this Amendment
as if the same were set out therein. The execution and delivery of this
Amendment by the undersigned has been duly authorized by all necessary
corporate action.
IN WITNESS WHEREOF the duly authorized representatives of the parties have
executed this Amendment as of the day and year first above written.
National Association Of Letter Carriers HealthCare COMPARE Corp.
Health Benefit Plan
By: Xxxxxxx X. Xxxxxxxxx By: X.X. Xxxxx
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President
Title: President
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Date: 1/3/94
---------------------------- Date:
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National Association of Letter Carriers
Health Benefit Plan
Schedule of Fees
Effective January 1, 1992 - December 31, 1992*
MEDICAL/SURGICAL HOSPITAL REVIEW . . . . . . . . . $1.39 per enrollee per month
CASE MANAGEMENT. . . . . . . . . . . . . . . . . . $200 per hour**
MENTAL HEALTH SERVICES REVIEW . . . . . . . . . . $0.24 per enrollee per month
Plus $200 per hour***
ADDITIONAL SERVICES:
Medical Record Photocopies . . . . . . . . . . . FEE WAIVED****
ADMINISTRATIVE RUN-OFF FEE. . . . . . . . . . . . . 50% of the final monthly fee
* Adjustments to fees will be made annually.
** The hourly charge is for time and services of staff personnel who may
be physicians, registered nurses, or allied personnel.
*** The hourly charge is the all activity associated with
practitioner-to-practitioner review and independent chart review.
**** COMPARE will photocopy 180 medical records per year at no charge to
NALC. Each record in excess of 180 will be billed at $100 per hour for
staffing and equipment costs.
November 22, 1991
rev. November 13, 1992
rev. December 9, 1993
