Summary: 2021 Revised ASO Agreement - Medica

This is a revised Administrative Services Organization (ASO) Agreement involving Medica and participating state and local entities. The agreement outlines the administrative services and claims processing functions that Medica will provide to self-funded health plans sponsored by the consortium members. The services encompass claims administration, customer service support, network management, and related operational functions necessary to maintain health insurance coverage for plan participants. The agreement establishes the operational framework and responsibilities for Medica as the ASO vendor, with specific performance standards and service level requirements outlined throughout the contract term. The agreement becomes effective upon execution and continues for the specified contract period with provisions for renewal options as negotiated between the parties.

The agreement includes pricing terms based on per-employee-per-month (PEPM) rates and administrative fees as detailed in the attached fee schedules. The arrangement may include set-aside provisions for specific service categories and dedicated funding allocations for participating entities. The agreement addresses incumbent services, performance metrics, and requirements for maintaining adequate reserves and financial stability. Salient provisions include termination rights, transition assistance requirements upon contract conclusion, and dispute resolution procedures. The document establishes compliance requirements with applicable state and federal healthcare regulations, including ERISA and state insurance laws, along with data security and confidentiality obligations to protect participant health information.