JOINT MARKETING AND NETWORK ACCESS AGREEMENT
This
Joint Marketing and Network Access Agreement is made by and between Employers
Insurance Company of Nevada, together with its affiliates and subsidiaries
(“EICN”), on the one hand, and Blue Cross of California, BC Life
& Health Insurance Company, and Comprehensive Integrated Marketing Services
(collectively, “Blue Cross”), on the other, effective as of July 1,
2006 (“Effective Date”).
RECITALS
A. Blue
Cross offers Large Group medical coverage products (“Large Group
medical”) in California.
B. Blue
Cross and Employers Insurance Company of Nevada are currently parties to that
certain Joint Marketing and Network Access Agreement, dated January 1, 2006
(the “Blue Cross-EICN Agreement”) under which Blue Cross and EICN
jointly market an integrated small group medical and workers’ compensation
product in California.
C. Blue
Cross and EICN desire to jointly offer and market integrated Large Group
medical and workers’ compensation product(s) under the terms specified
herein.
D. Blue
Cross and EICN desire to enter into this Agreement in order to provide a full
statement of their respective responsibilities.
E. The
services to be performed by Blue Cross hereunder shall be performed by BC Life
& Health Insurance Company and Comprehensive Integrated Marketing Services
(“CIMS”).
F. The
services to be performed by EICN hereunder shall be performed by Employers
Compensation Insurance Company and Employers Insurance Company of
Nevada.
NOW,
THEREFORE, it is
agreed as follow:
AGREEMENT
1. Scope
of Agreement.
Subject to the terms of this Agreement, Blue Cross and EICN agree to jointly
market an integrated Large Group medical and workers’ compensation
product(s) (the “Integrated Product” ‘as further defined in
Exhibit A hereof) on an exclusive basis in the state of California. The terms
of such exclusivity are defined in Paragraph 14 (a) of this Agreement. The
scope of this Agreement may be expanded to other states by an Addendum to this
Agreement agreed to and executed by both parties.
2. Term. The
initial term of this Agreement shall be for two (2) years commencing on the
Effective Date unless terminated sooner as provided in Paragraph 12 of this
Agreement. Thereafter, this Agreement shall automatically renew for subsequent
one (1) year term unless written notice of non-renewal of this Agreement (a
“non-renewal notice”) has been provided by one party to the other at
least 60 days prior to the expiration of the then current term.
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
3. Distribution
of Product.
(a) The
Integrated Product will use the Blue Cross distribution system, including
employees, brokers, and general agents (collectively “Blue
Cross Producers”). EICN shall cooperate with Blue Cross in making any
necessary agency appointments or entering into any necessary brokerage or
agency agreements needed to allow Blue Cross Producers to market and sell EICN
workers’ compensation products as contemplated by this
Agreement.
(b) Blue
Cross will administratively make commission payments to Blue Cross Producers
for all coverage placed through the Blue Cross Producers and billed by Blue
Cross. EICN will pay commissions due to Blue Cross producers for coverage
billed by EICN.
4. Underwriting. Blue
Cross will exclusively control Large Group medical product underwriting and
eligibility, and EICN will exclusively control workers’ compensation
underwriting and eligibility. Neither Blue Cross nor EICN will be bound to
offer an Integrated Product in instances in which either party is unwilling to
assume underwriting risk consistent with its underwriting policies for its
component of the Integrated Product.
Each
party will, at a minimum, maintain and share with the other party on a
confidential basis underwriting guidelines, class restrictions and operational
practices during the term of this Agreement in connection with its component of
the Integrated Product, including, but not limited to, classes written,
eligible groups, etc. Substantial changes in such underwriting guidelines,
restrictions and practices which significantly and materially affect the
nature, scope or classes of business written shall be made by mutual consent,
or unilaterally by a party after giving written notice to the other party in
the event of a significant adverse change in external factors which a party
believes in good faith requires a revision to its underwriting guidelines,
restrictions or practices. The parties will use commercially reasonable efforts
to extend the number of classes written and eligible groups for both
workers’ compensation and Large Group medical.
5. Advertising/Marketing
Materials. Blue
Cross shall be responsible for marketing and advertising of the Integrated
Product. All advertising and collateral material for the Integrated Product to
be distributed by Blue Cross, including materials developed and utilized in
conjunction with EICN, will be prepared by Blue Cross and must be jointly
approved by both parties. The Executive Sponsors shall develop an expedited
process for review, approval and use of standardized forms or other frequently
used advertising or marketing materials. EICN may, at its own expense, prepare
its own marketing and promotional materials for the Integrated Product, but use
of any such materials shall be subject to Blue Cross’s prior
approval.
Blue
Cross and EICN agree that mutually acceptable product names and logos for the
Integrated Product in California have been established. Each party will retain
complete ownership and control of its own service marks, trademarks, trade
names, logo types or any similar intellectual property and will execute any
reasonable license agreements requested by the other party. Neither party shall
use any such intellectual property of the other without the other’s prior
written approval. Each party will be entitled to market the other party’s
networks available for the Integrated Product, subject to approval of any
written promotional materials by the other
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
party.
Any new product names, logos, or similar intellectual property developed for
the Integrated Product shall be jointly owned and, as appropriate, registered,
by Blue Cross and EICN, subject to the provisions of Paragraph 15 of this
Agreement.
It is
understood that all Advertising and Marketing materials will disclose that Blue
Cross assumes no responsibility for payment of workers’ compensation
claims, and that EICN assume no responsibility for payment of Large Group
medical claims.
6. Loss
Control. EICN
will perform all duties related to loss control procedures for the
workers’ compensation portion of the Integrated Product as required by law
or by EICN’s internal procedures as they may be amended from time to time.
Blue Cross shall comply with any similar legal requirements relating to Large
Group medical.
7. Premium
Collection & Audit.
(a) Billing. Blue
Cross will prepare and distribute a single, integrated Large Group medical and
workers’ compensation premium xxxx in a manner consistent with current
practices. EICN will supply to Blue Cross all data required for such billing.
Blue Cross will process payments for EICN’s portion of the integrated
billing and remit EICN’s portion of the premiums (net of administrative
fees and commissions) monthly to EICN within fifteen (15) days after the end of
the month in which they were received by Blue Cross. Collection of
non-integrated xxxxxxxx as well as any delinquent workers’ compensation
premium will be the responsibility of EICN. Collection of any delinquent
medical premium will be the responsibility of Blue Cross.
(b) Audit
and Collections. EICN
will perform all interim and final payroll audits for workers’
compensation premium. For additional workers’ compensation premium
adjustments, EICN will directly xxxx the customer and collect the premium. EICN
will be responsible for payment of any commissions up to Blue Cross Producers
for all non-integrated xxxxxxxx. For return premium adjustments, EICN will be
responsible for making any return premium payments directly to the customer for
the workers’ compensation product. EICN will also be responsible for
collecting any commissions due back from Blue Cross producers associated to
these refunds. Blue Cross will be responsible for all audit and collection
responsibilities for the Large Group medical product.
(c) Other. The
parties agree to share appropriate information concerning administering agents
and customers who initially select an Integrated Product and then discontinue
coverage of one segment; including information concerning the discontinuation
of coverage and the effective date of discontinuation.
8. Claims
& Reporting.
(a) Blue
Cross Duties. Blue
Cross shall perform all claims functions for the Large Group medical portion of
the Integrated Product and all Large Group medical regulatory reporting
requirements. Blue Cross shall have, no responsibility for payment of
workers’ compensation claims.
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
(b) EICN
Duties. EICN
shall perform all claims functions for the workers’ compensation portion
of the integrated Product. In addition, EICN will be responsible for all
medical ease management and utilization review and satisfy all workers’
compensation regulatory and statistical reporting requirements. EICN shall have
no responsibility for payment of Large Group medical claims.
(c) Joint
Duties. Blue
Cross and EICN shall share such medical, claim and benefit information to the
extent and in any manner permitted by law as may be necessary or desirable in
connection with the administration of the Integrated Product, including, but
not limited to, the purposes of detecting fraud and assuring proper payment
under the appropriate coverage.
9. Network
Access.
(a) During
the term of this Agreement and as provided in Paragraph 13(a), Blue Cross
agrees to provide EICN access to the following Blue Cross California networks
for the Integrated Product:
Prudent
Buyer Comp Provider professional network
Prudent
Buyer Provider professional network
Frontline
Occupational professional network
Certain
specialty networks related to chiropractic and physical therapy
Prudent
Buyer institutional network.
(b) The
foregoing shall be referred to collectively as the “Blue
Cross Networks” and the contracted hospitals, physicians, and other
ancillary health care providers and facilities included within the Blue Cross
Networks shall be referred to as the “Blue Cross Providers.” The
rates Blue Cross Providers are, entitled to receive pursuant to provider
agreements with Blue Cross shall be referred to as the “Blue Cross
Contracted Rates.”
Blue
Cross agrees that it will maintain the Blue Cross Networks in California so as
to adequately offer and provide the medical services (“Medical
Services”) to injured workers covered by the workers’ compensation
component of the Integrated Product (“Eligible Employees”) in those
parts of California in which the Integrated Product is offered. Issues related
to the adequacy of the Blue Cross Networks and the locations in which the
Integrated Product shall be offered shall be considered and resolved by
consultation between the Executive Sponsors. With respect to the Blue Cross
Networks, Blue Cross represents and warrants to EICN as follows: (i) that at
the time it entered into its provider agreements with Blue Cross Providers, it
required and verified that those providers were duly licensed and had
professional liability insurance with limits in compliance with Blue
Cross’s then current credentialing standards; (ii) that as of the
Effective Date a substantial majority of California Blue Cross Providers have
been credentialed under Blue Cross’s current credentialing requirements, a
copy of which has been provided to EICN and which requirements include the
professional liability insurance minimum limits specified in Paragraph 17
hereof and that at all times during the term of this Agreement, credentialing
requirements shall be actively monitored by Blue Cross; (iii) that, as of the
Effective Date and at all times during the term of this Agreement, California
Blue Cross Providers that have not been credentialed in accordance with Blue
Cross’s current
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
credentialing
requirements are being actively monitored for potential noncompliance with
those requirements; (iv) that as of the Effective Date it has in all material
respects complied, and at all times during the term of this Agreement will
comply with all laws and regulations regarding the inclusion or exclusion of
California providers in the Blue Cross Networks and with respect to the
provision of medical services to injured workers under the workers’
compensation laws as contemplated by this Agreement; and (v) that, as of the
Effective Date and at all times during the tern, of this Agreement, it is and
will be duly licensed, registered and/or certified by the appropriate state
agency(ies) of any state requiring it to be so licensed, registered and/or
certified in order to perform its obligations and responsibilities under the
terms and conditions of this Agreement.
(c) Blue
Cross will use commercially reasonable efforts to ensure that, at all times
during the term of this Agreement, all Blue Cross Providers provide access to
EICN at the most favorable rates available for insured products which integrate
Large Group medical and workers compensation product(s) under their agreements
with Blue Cross and accept such rates as payment in full for Medical Services
to Eligible Employees, and shall give EICN prompt notice of any circumstance
under which it is unable to do so. Blue Cross shall provide EICN with access to
Blue Cross’s
Provider Finder. To the extent applicable and in the possession of Blue Cross,
such listing shall include each Blue Cross Provider’s address, telephone
number, facsimile machine number, taxpayer identification number, professional
or institutional license number, specialty, and professional or group
affiliation. Blue Cross may provide access to the Blue Cross Networks to other
workers’ compensation insurers or self-insured entities; provided,
however, that at all times during the term of this Agreement, Blue Cross agrees
that the network access fees provided to EICN in connection with the Integrated
Product shall be lower than any network access fees provided to any other
workers’ compensation insurer for any insured products which integrates
Large Group medical and workers’ compensation, and the scope and breadth
of the Blue Cross Networks provided to EICN in connection with the Integrated
Product shall be broader than the scope and breadth of the Blue Cross Network
access provided to any other workers’ compensation insurer for any insured
products which integrate Large Group medical and workers’ compensation
product(s). Notwithstanding the foregoing, Blue Cross may continue to offer
both network access contracts, including but not limited to those currently in
effect with the California State Compensation Insurance Fund, Western Growers
Insurance Company, and Springfield Insurance Company, GMIS, and managed care
service arrangements, Blue Cross agrees that its workers’ compensation
network access contracts and workers’ compensation managed care service
agreements may not be advertised or marketed by Blue Cross or the other parties
to such arrangements as insured Integrated Products in California.
(d) EICN
reserves the right to supplement Blue Cross Networks for the Integrated Product
by use of it own proprietary networks or contracted networks with the prior
approval of Blue Cross. EICN also reserves the right to contract directly with
providers who are or later become Blue Cross Providers. However, should a
provider be included in both the Blue Cross and EICN networks, the Blue Cross
provider contract shall be utilized for the Integrated Product.
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
(e) Blue
Cross shall require that each Blue Cross Provider shall, at all times, provide
treatment to Eligible Employees in a manner consistent with sound professional
judgment and practice. Nothing in this Agreement is intended to require (or
shall be construed to require) a Blue Cross Provider to take any action
inconsistent with its professional judgment, or refrain from taking any action
consistent with its professional judgment, concerning the professional medical
care and treatment to be provided to an Eligible Employee.
10. Confidentiality
of Medical Records and Privacy. To the
extent required by law, Blue Cross and EICN shall keep, confidential, and to
take the usual precautions to prevent the unauthorized disclosure of, any and
all medical records required to be prepared or maintained by Blue Cross or
EICN. Blue Cross and EICN will comply with all federal and state laws and
regulations regarding privacy including those involving non-public personal
information.
11. Administrative
Fee. EICN
will pay Blue Cross’ insurance agency subsidiary, CIMS, an administrative
fee (the “Administrative Fee”) in accordance with the following
schedule for all other services performed by Blue Cross under this
Agreement:
Percentage
of Collected California
Workers’
Compensation Premium |
Annual
Collected California Workers’ Compensation Integrated Premium |
|
****%
|
*****************,
plus |
|
****%
|
*****************,
plus |
|
****%
|
*****************
|
The
Administrative Fee shall be billed to EICN on a monthly basis and may, at Blue
Cross’s discretion, be deducted and withheld from monies owed by Blue
Cross to EICN, or if Blue Cross elects not to withhold the Administrative Fee
from amounts owed to EICN, shall be paid by EICN within fifteen (15) days of
its receipt of the pertinent billing. The Administrative Fee shall be based
solely on collected integrated premiums (excluding assessments) for that
portion of policyholder xxxxxxxx relating to periods on or after the Effective
Date and ending on the date of termination of this Agreement.
Pro-rata
adjustments shall be made for premiums collected after the Effective Date or
date of termination that relate to policyholder xxxxxxxx which include periods
prior to the Effective Date or after the date of termination of this Agreement.
The Annual California Workers’ Compensation Integrated Premium amount
shall be defined as the amount of premium billed and collected through the Blue
Cross integrated policyholder xxxxxxxx (net of assessments and any balance
assigned to EICN direct collections) on that portion of policyholder xxxxxxxx
relating to the annual period beginning on the Effective Date, or anniversary
thereof, as the case may be.
12. Termination.
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
(a) Termination
Without Cause. After
the first year that this Agreement is in effect, either party shall have the
right to terminate this Agreement without cause upon providing sixty (60) days
prior written notice to the other party.
(b) Termination
For Cause. Either
party shall have the right to terminate this Agreement upon providing thirty
(30) days prior written notice to the other party if the party to whom such
notice is given has materially breached any provision of this Agreement. The
party claiming the right to terminate shall set forth in the thirty (30) days
notice of termination, the facts underlying its claim that the other party is
in breach of this Agreement. Cure of such breach within fifteen (15) days of
the receipt of such notice shall continue the Agreement for the remaining term,
subject to other rights of termination contained in this
Agreement.
(c) Immediate
Termination. Either
party shall have the right to terminate this Agreement immediately upon written
notice to the other party in the event of:
i.
|
failure
to obtain, or suspension, revocation or restriction of a regulatory license or
approval required for a party to perform under this Agreement;
|
ii.
|
an
indictment charging or conviction of, any officer of either party of a felony
or of a crime involving moral turpitude as it relates to the operation of this
Agreement; |
iii.
|
insolvency,
liquidation, conservatorship, rehabilitation or receivership of a party, or the
commencement of any proceedings regarding same; |
iv.
|
an
assignment in violation of Paragraph 29(d) of this Agreement or the entering
into of a sale transfer or reinsurance arrangement in violation of Paragraph
7(c) hereof. |
(d) Termination
(And Other Relief) For Failure To Make Available Provide Coverage Through B++
Rated Carrier. EICN
shall, in connection with the Integrated Product, (i) provide all workers’
compensation coverage through a carrier rated “B++” or better by A.M.
Best Company, and (ii) shall make such coverage available upon commercially
reasonable terms consistent with terms available in the market place. Should
EICN at any time fail to comply with the requirements of (d)(i) or (d)(ii),
Blue Cross shall at its option, without prejudice to any other available rights
or remedies, and upon written notice to EICN, be excused from performance under
Section 14 of the Agreement. Furthermore, in such event Blue Cross may at its
option, without prejudice to any other available rights or remedies,
immediately to mate the Agreement. A waiver of either remedy with respect to
any default shall not act as a waiver as to any further default.
(e) Survival
Post-Termination. The
termination of this Agreement shall not affect any rights or obligations
hereunder which by their nature relate to obligations required to
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
be
performed, completed or adhered to following termination, including, but not
limited to, Paragraphs 5, 7, 8, 10, 11, 13, 14, 16, 20, 22, 24, and
26.
13. Service
Obligations Upon and After Termination.
(a) Blue
Cross Network Provider Services. Blue
Cross agrees, and shall ensure that Blue Cross Providers also agree, that Blue
Cross Providers’ responsibilities to an Eligible Employee upon termination
of this Agreement shall continue until the Medical Services being rendered to
any such Eligible Employee as of the effective date of termination are
completed and that during such time as EICN shall remain financially liable to
such Blue Cross Provider for Medical Services provided to such Eligible
Employee. EICN shall reimburse the Blue Cross Provider for medical services
rendered after termination of this Agreement in accordance with the Blue Cross
Contracted Rates and shall continue to be responsible for payment of the
related network access fees to Blue Cross. Blue Cross shall cooperate, and
shall use commercially reasonable efforts to cause Blue Cross Providers to
cooperate, with EICN in the event that EICN is required, pursuant to any
litigation or settlement negotiations with an insured or Eligible Employee over
medical services provided to such Eligible Employee, to justify its managed
care decision(s), including any utilization review and other medical management
determinations. All relevant provisions of Paragraph 6 shall continue in effect
following termination as necessary to effectuate the intent of this
Paragraph.
(b) Premium
Collection, Billing, And Xxxx Review. As of
the effective date of termination, or earlier if agreed by the parties EICN
shall assume responsibility for billing and collection of the formerly
integrated portion of premiums for the workers’ compensation component of
the Integrated Product and for review of all new bills. Blue Cross shall
provide EICN with all data and information necessary for EICN to assume or to
have a third party assume responsibilities formerly provided by Blue
Cross.
14. Exclusivity
and Non-Solicitation of Other Party’s Business.
(a) Blue
Cross and EICN agree that neither party shall enter into another joint
marketing agreement for an Integrated Product with a third party during the
term of this Agreement for the writing of Large Group business in California
(or any additional states later added by addendum to this Agreement) until the
expiration of a one hundred twenty (120) day period following written notice to
the other party of its intent to do so. Nothing in this Agreement shall be
construed herein as to preclude either Blue Cross or EICN from independently
offering (either directly or through brokers) stand-alone Large Group medical
or workers’
compensation coverage, respectively, or from entering into third party
arrangements not related to an insured integrated Large Group
medical/workers’ compensation product (including but not limited to
workers’ compensation managed care services arrangements not related to an
insured integrated Large Group medical/workers’ compensation product). In
addition, nothing shall preclude either party from: (a) continuing current
integrated products, (b) continuing existing integrated operations obtained via
acquisitions subsequently made, or (c) continuing insured operations
subsequently acquired.
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
(b) It is
further agreed that, prior to the termination of this Agreement, Blue Cross
shall not solicit, individually or jointly with others through a joint venture
or otherwise, or provide any information allowing a third party to solicit, any
California policyholders or former policyholders of EICN, who have purchased or
renewed the Integrated Product during the term of this Agreement, for the
purpose of causing such policyholders to purchase a policy of workers’
compensation insurance which is not part of the Integrated Product and subject
to this Agreement. Likewise, prior to the termination of this Agreement, EICN
shall not solicit, individually or jointly with others, or provide any
information allowing a third party to solicit, any California subscribers or
policyholders or former subscribers or policyholders of Blue Cross who have
purchased or renewed the Integrated Product during the term of this Agreement,
for the purpose of causing such policyholders or subscribers to purchase Large
Group medical coverage which is not part of the Integrated Product and subject
to this Agreement.
(c) If,
prior to the termination of this Agreement, either party sells or offers to
sell, transfer or reinsure (pursuant to a 100% reinsurance and assumption
agreement) to a non-affiliated third party any part of its business that is or
has been part of or associated with the Integrated Product and is subject to
this Agreement, that party shall provide written notice of its intention to the
other party. The party receiving such notice shall be given a reasonable
opportunity to either purchase such business itself on mutually acceptable
terms or meet and confer with the prospective purchaser of such business for
the purpose of negotiating with such prospective purchaser a continuation of
some or all of the terms of this Agreement. Nothing in this Agreement shall
impose any obligation on such purchaser unless so agreed by the purchaser. If a
sale or transfer pursuant to this Paragraph relates substantially to one or
more jurisdictions subject to the exclusivity provisions of this Agreement, the
non-selling party shall be released from the exclusivity provisions of this
Agreement with respect to such jurisdiction or jurisdictions. In the event of a
sale, transfer or reinsurance arrangement as described above by the selling
party which would reasonably be expected to reduce by fifty percent (50%) or
more that party’s expected annual premium from the Integrated Product, the
non-selling party shall have a right to terminate this Agreement upon the
completion of such sale, transfer or reinsurance arrangement.
15. Jointly
Owned Intellectual Property. It is
agreed that upon termination of this Agreement any jointly owned product names
or other jointly owned-intellectual property (excluding any listing of brokers,
subscribers or policyholders associated with the Integrated Product) may not be
used by either party until the parties mutually agree otherwise or one party
purchases all rights to such intellectual property from the other in accordance
with the following procedure. Either party may offer the other party the right
to both purchase or sell the intellectual property at a specified price. The
parry receiving the offer shall have ten (10) business days to elect to
purchase or sell such properly at such price. Thereafter the parties shall
execute a mutually acceptable agreement transferring all rights in the
intellectual property accordingly.
16. Indemnification. To the
fullest extent allowed by law, Blue Cross shall indemnify and hold harmless
EICN, its subsidiaries, affiliates, agents and their directors, officers,
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
employees
and agents, for any claim, demand, loss, lawsuit, settlement, judgment, or
other liability, and all related expenses which may accrue, arising from or in
connection with a claim of a third party arising from a negligent or otherwise
wrongful act or omission of Blue Cross, its agents, or employees (including but
not limited to any failure by Blue Cross to pay an Integrated Product Large
Group medical claim). EICN shall provide Blue Cross with written notice within
ten (10) business days of discovering the existence of any claim, demand or
other matter to which the indemnification obligations contained herein would
apply, and shall include with such notification a true copy of any and all
complaints, correspondence documents, and other materials relating to such
claim, suit, proceeding, action or demand. Upon request, Blue Cross shall
provide EICN with written assurance that it will defend EICN, at Blue
Cross’s expense and with counsel of EICN’s selection. If Blue Cross
should fail to provide EICN with such written assurance, or otherwise fails to
defend EICN, EICN, upon written notice to Blue Cross, shall have the right, but
not the obligation, to undertake the defense of, and to compromise and settle
(exercising reasonable business judgment) the claim, demand, suit, proceeding
or action on behalf, for the account, and at the risk of, Blue
Cross.
To the
fullest extent allowed by law, EICN shall indemnify and hold harmless Blue
Cross, its subsidiaries, affiliates, agents and their directors, officers,
employees and agents, for any claim, demand, lose, lawsuit, settlement,
judgment, or other liability, and all related expenses which may accrue,
arising from or in connection with a claim of a third party arising from a
negligent or otherwise wrongful act or omission of EICN, its agents or
employees (including but not limited to any failure by EICN or by any companly
on whose paper Integrated Product workers’ compensation coverage is
written to pay any Integrated Product workers’ compensation claim). Blue
Cross shall provide EICN with written notice within ten (10) business days of
discovering the existence of any claim, demand or other matter to which the
indemnification obligations contained herein would apply, and shall include
with such notification a true copy of any and all complaints, correspondence,
documents, and other materials relating to such claim, suit, proceeding, action
or demand. Upon request, EICN shall provide Blue Cross with written assurance
that it will defend Blue Cross, at EICN’s expense and with counsel of Blue
Cross’s selection. If EICN should fail to provide Blue Cross with such
written assurance, or otherwise fails to defend Blue Cross, Blue Cross, upon
written notice to EICN, shall have the right, but not the obligation, to
undertake the defense of, and to compromise and settle (exercising reasonable
business judgment) the claim, demand, suit, proceeding or action on
behalf’, for the account, and at the risk of, EICN.
If each
party claims and is entitled to indemnity from the other, the liability of each
to the other shall be determined according to principles of comparative fault.
Indemnity shall include damages, reasonable costs, reasonable expense, and
reasonable attorney’s fees as incurred by the party
indemnified.
17. Insurance. Blue
Cross shall require Blue Cross Providers to carry and maintain appropriate
professional liability insurance with limit of no less than One Million Dollars
($1,000,000) for any single incident and Three Million Dollars ($3,000,000)
aggregate (or such lower limits which Blue Cross’s provider contracts
permit Blue Cross Providers to carry in certain jurisdictions because of lower
local provider community standards for maintenance of insurance).
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
18. Notice.
Notices under this Agreement shall be addressed as follows:
To Blue Cross at:
00000
Xxxxxx Xx., 0X
Xxxxxxxx
Xxxxx, XX 00000
Attention:
Xxxxxxxx X. Xxxxxxx
Vice
President & General Manager Key & Major Accounts,
BCC
Large Group
and
Xxx
XxxxXxxxx Xxx
Xxxxxxxx
Xxxx, XX 00000
Attention:
General Counsel
To EICN at:
Employers
Compensation Insurance Company
000
Xxxxx Xxxxx Xxxx,
Xxxxx
000
Xxxxxxxx,
XX 00000
Attention:
Xxxxx Xxxxxxx, President
Strategic
Markets Region
Employers
Compensation Insurance Company
0000
Xxxxxxx Xxxxx, Xxxxx 000
Xxxx, XX
00000
Attention:
General Counsel
19. Binding
Agreement.
Subject to Paragraph 29(d) hereof, this Agreement shall be binding upon and
inure to the benefit of the successors and assigns of the parties
hereto.
20. Governing
Law. This
Agreement shall be governed by and construed in accordance with the internal
laws of the State of California without regard to conflicts of laws principles
thereof.
21. Management
of Integrated Product. The
parties agree that the success of the Integrated Product will require
continuous communication and coordination between the managements of EICN and
Blue Cross. Each party shall appoint a Senior Officer as an Executive Sponsor
who shall for that party make all decisions related to the underwriting,
distribution, marketing, advertising and other administration of the Integrated
Product pursuant to this Agreement. The Executive Sponsors shall meet no less
frequently than annually to review outstanding issues and the performance of
the program, including all marketing and advertising issues. Xxxxx Xxxxxxx is
designated as the initial Executive Sponsor for EICN and Xxxxxxxx X. Xxxxxxx is
designated as the initial Executive Sponsor for Blue Cross. Each party may
designate a replacement Executive Sponsor upon written notice to the
other.
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
22. Dispute
Resolution and Arbitration. Any
controversy, claim or dispute arising out of or relating to this Agreement, or
any other matter between or among the parties hereto, their assignees,
affiliates, attorneys, or agents, shall be settled by binding arbitration in
Los Angeles County, California. Arbitration shall be conducted in accordance
with the currently prevailing commercial arbitration rules of the American
Arbitration Association, but shall be before J.A.M.S./Endispute
(“JAMS”), with the following exceptions if in conflict: (a) one
neutral arbitrator shall be chosen by JAMS if the parties are first unable to
mutually agree on one arbitrator; (b) each party to the arbitration will pay
its pro rata share of the expenses and fees of the arbitrator, together with
other expenses of the arbitration incurred or approved by the arbitrator; and
(c) arbitration may proceed in the absence of any party if written notice
(pursuant to the American Arbitration Association’s rules and regulations)
of the proceedings has been given to such party. The parties agree to abide by
all decisions and awards rendered in such proceedings. Such decisions and
awards rendered by the arbitrators) shall be final and conclusive and may be
entered in any court having jurisdiction thereof as a basis of judgment and of
the issuance of execution for its collection. All such controversies, claims or
disputes shall be settled in this manner in lieu of any action at law or
equity. The arbitrator shall not have the power or authority to award punitive
damages, consequential damages, lost profits or speculative damages, but shall
be empowered to award equitable remedies as appropriate. The parties shall keep
confidential the existence of the claim, controversy or disputes from third
parties (other than the arbitrator), and the determination thereof, unless
otherwise required by law. IF FOR ANY REASON THIS ARBITRATION CLAUSE BECOMES
NOT APPLICABLE, THEN EACH PARTY, TO THE FULLEST EXTENT PERMITTED BY APPLICABLE
LAW, HEREBY IRREVOCABLY WAIVES ALL RIGHT TO TRIAL BY JURY AS TO ANY ISSUE
RELATING HERETO IN ANY ACTION, PROCEEDING, OR COUNTERCLAIM ARISING OUT OF OR
RELATING TO THIS AGREEMENT OR ANY OTHER MATTER INVOLVING THE PARTIES
HERETO.
23. Independent
Contractor Status.
(a) At all
times, the relationship between the parties hereto shall be that of independent
entities contracting with one another at arm’s
length toward an independent contractor relationship. Neither party shall be
deemed the agent of the other, and no joint venture or partnership shall be
deemed to result from this Agreement.
(b) Neither
party shall have the authority to bind the other, nor propose to do so in any
dealings with third parties.
24. Confidentiality
and Proprietary Rights.
(a) Each
party acknowledges that the other party’s
confidential information constitutes valuable property and trade secrets of the
other party, which are entitled to protection. Subject to the following two
sentences, each party shall hold all confidential information of the other
party in strict confidence and neither party nor any of its affiliates or
representatives shall directly or indirectly: a) use or permit the use of any
of the confidential information for, or in connection with, any business of the
other or any affiliated company, its representatives of any other person
whatsoever, or for any purpose other than the performance under this Agreement,
or b) disclose or permit the disclosure
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
of any
of the other party’s confidential information to any person or entity
other than the other party’s representatives. However, the agreement to
hold confidential information in confidence and not to disclose it shall not
extend to the following information that would otherwise constitute
confidential information.
i.
|
Information
that, at the time of the use or disclosure, was readily ascertainable from
public sources or was known by or available to competitors, clients or
customers of either party, by publication or otherwise, except for sources
which arise by virtue of this Agreement; |
ii.
|
Information
that comes into one party’s
possession from a third party and that was not acquired by such third party
from the other in violation of such third party’s obligations of
confidentiality. |
iii.
|
Information
that has become generally available to the public through no act or omission of
the receiving party or any of its subsidiaries or representatives;
or |
iv.
|
Information
required to be disclosed by law, regulation or judicial or administrative
order. In addition, either party may disclose confidential information of the
other party to the disclosing party’s legal counsel. |
(b) Notwithstanding
anything to the contrary in this Paragraph 24, EICN is not restricted from
directly contracting with any of the Blue Cross Providers during the term of
this Agreement or otherwise, and, following termination of this Agreement,
neither party shall be restricted in using information regarding the brokers,
subscribers and policyholders associated with the Integrated
Product.
(c) Other
than in furtherance of such party’s
obligations under this Agreement, neither party shall duplicate, copy or
reproduce any of the confidential information except with the prior consent of
the other party, or except for review by such party’s officers or
shareholders or their representatives. if either party consents to the copying
of any confidential information, then the receiving party or its
representative, as the case may be, may make duplicate copies of the
confidential information but such duplicate copies shall be subject to all of
the provisions of this Agreement including, without limitations, the provisions
set forth in this Section.
(d) Within
ten (10) days after a party receives a written request from the other party for
the return of confidential information, the receiving party shall deliver all
documents constituting such confidential information, including all copies,
reproductions, extracts and summaries of such confidential information to such
requesting party except to the extent that such confidential information
relates to a client of the receiving party and is necessary to continue to meet
the obligations of the receiving party to its client or must be maintained to
document the services provided to client. Any portion of the confidential
information that consists of analysis, computations, studies or notes prepared
by the
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
receiving
party or its representatives, shall be either held by the receiving party and
kept confidential subject to the terms of this Agreement or
destroyed.
(e) Without
in any way limiting any other obligations or liability of each party under this
Agreement, each party shall take all appropriate and reasonable action by
instruction or otherwise, to prevent the unauthorized use, disclosure or
copying of confidential information, and shall take reasonable precautions to
protect and maintain the confidentiality of the confidential information. Each
party shall advise its representatives of the terms of this Section, and use
reasonable efforts to cause each of them to comply with its terms. Each party
shall immediately notify the other of the circumstances surrounding any breach
of this Paragraph of which any party becomes aware.
(f) Each
party agrees that if it breaches any provision of this Paragraph 24, the other
party may not have an adequate remedy at law, and, in addition to any other
available remedies, the damaged party is entitled to injunctive relief against
the breaching party.
(g) Without
limiting the scope of the term “confidential information,” the
parties specifically agree that the term includes pricing (including network
contract rates), rating, eligibility and other underwriting information of each
party.
25. Books,
Records, And Financial Reporting.
(a) EICN
shall have the right through its representatives to make an examination and
audit, at EICN’s
sole expense, upon reasonable prior notice and subject to such written
agreement as Blue Cross shall reasonably determine may be necessary or
desirable to protect confidential, proprietary of trade secret information,
during normal business hours, of any records kept pursuant to this Agreement by
Blue Cross as may, under recognized accounting practices, contain information
bearing upon the amount of fees payable to EICN or Blue Cross under this
Agreement or as to the services provided by Blue Cross under this Agreement.
Prompt adjustment shall be made by the proper party to compensate for any
errors or omissions disclosed by such examination or audit which are accepted
by the party to be charged as correct. Any such audit shall not, however, be
conducted by any person or entity which is related to, or is affiliated with, a
competitor of Blue Cross.
(b) Blue
Cross shall have the right through its representatives to make an examination
and audit, at Blue Cross’s sole expense, upon reasonable prior notice and
subject to such written agreement as EICN shall reasonably determine may be
necessary or desirable to protect confidential, proprietary of trade secret
information, during normal business hours, of any records kept pursuant to this
Agreement by EICN as may, under recognized accounting practices, contain
information bearing upon the amount of fees payable to EICN or Blue Cross under
this Agreement or as to the services provided by EICN under this Agreement.
Prompt adjustment shall be made by the proper party to compensate for any
errors or omissions disclosed by such examination or audit which are accepted
by the party to be charged as correct. Any such audit shall not, however, be
conducted by any person or entity which is related to, or is affiliated with, a
competitor of EICN.
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
(c) EICN
will furnish Blue Cross with copies of quarterly and annual financial
statements as filed with the Insurance regulatory or it domiciliary state when
requested by Blue Cross.
26. General
Provisions.
(a) Non-solicitation
of Employees. For
the period commencing on the effective date of this Agreement and ending on the
day that is one (1) year after termination of this Agreement, neither party
shall, solicit to hire or solicit to employ any employee of the other party or
induce or endeavor to induce any employee of the other party to leave his or
her employment, other than as part of a general solicitation of employees not
directed specifically to the other party or the other party’s employees.
For purposes hereof, the term “employee” shall not include a person
whose employment has been terminated or who has been given notice that he or
she is to be terminated.
(b) Waiver. The
waiver by either party of a breach or a violation of any provision of this
Agreement shall not operate or be construed to operate as a waiver of any
subsequent breach hereof.
(c) Entire
Agreement. This
Agreement contains all the terms and conditions agreed upon by the parties
hereto regarding the subject matter of this Agreement. Any prior agreements,
promises, negotiations, or representations, either oral or written, relating to
the subject matter of this Agreement not expressly set forth in this Agreement
are of no force or effect.
(d) Assignment. This
Agreement, including the right to receive money, shall not be assigned without
the prior written consent of the parties, which consent shall not be
unreasonably withheld; and any purported assignment made contrary hereto shall
be void as to the non-assigning party. For purposes of this Paragraph, the term
“assignment” shall include an assignment by operation of law (by
merger or otherwise), or a change in control of the majority of the outstanding
shares of Blue Cross or EICN. Consent may be withheld by either party if the
proposed assignee fails to execute an agreement similar to this Agreement
satisfactory to either party, or if any payments remain due either party at the
time of such assignment. Notwithstanding, the foregoing, the parties agree that
either party shall be free without the other’s consent to assign rights or
delegate duties to an affiliate or wholly-owned subsidiary.
(e) Third
Party Beneficiary Rights. It is
not the intent of the Agreement to create any third party beneficiary rights in
Blue Cross providers or anyone else and this Agreement shall not be deemed to
create any such rights.
(f) Amendment. This
Agreement may be amended, supplemented or modified only by a written instrument
duly executed by or on behalf of each party hereto. The parties agree to
negotiate in good faith appropriate amendment(s) to this Agreement, upon the
request of one party to either expand joint marketing activities to include
medical coverage written by Blue Cross affiliates in state other than
California or to expand joint marketing activities to include medical coverage
written by Blue Cross’ Large Group division.
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
IN
WITNESS WHEREOF, the
parties hereto have caused this Agreement to be executed by their respective
officers or agents thereunto duly authorized, as of the Effective
Date.
BLUE CROSS | EICN | ||
/s/ Xxxxxxxx X. Xxxxxxx | /s/ Xxxxxx X. Xxxxx | ||
Xxxxxxxx
X. Xxxxxxx
VP &
General Manager
Blue
Cross of California Large Group |
Xxxxxx
X. Xxxxx
President
and Operating Officer |
*
Confidential treatment has been requested with respect to certain portions of
this exhibit. Such portions are marked with a “[*]” in place of the
redacted language. Omitted portions are filed separately with the Securities
and Exchange Commission.
EXHIBIT
A
DEFINITION
OF INTEGRATED PRODUCT
The
Integrated Product shall be defined by the following:
Customer
Group:
California employer groups designated and classified by Blue Cross as
“Large Group business” and written by Blue Cross.
Products
Offered:
Blue
Cross: insured Large Group medical products.
EICN:
insured workers’ compensation coverage.
For
purposes of exclusivity, an Integrated Product is defined as any insured
product sold or offered to Customer Groups for which Blue Cross offers Large
Group medical coverage and EICN offers workers’ compensation coverage and
which has joint marketing collateral and a jointly utilized network
arrangement.
New
Product Design and Approval: Both
parties are encouraged to design and implement new components of Integrated
Products during the course of the Agreement. Mutual consent as to the joint
structure and combination of any new components of Integrated Products will be
required. Examples of product design considerations include but are not limited
to: products offered, product decisions and approval.
Pricing: EICN
anticipates that it will continue to offer a workers’ compensation rate
adjustment on an Integrated Product; however, EICN may adjust or terminate such
rate adjustment at its discretion.
* Confidential treatment has been requested with respect to
certain portions of this exhibit. Such portions are marked with a
“[*]” in place of the redacted language. Omitted portions are filed
separately with the Securities and Exchange Commission.