CSP900320_DAS032_Contract_Rev.pdf

Index No.: DAS032

Eff. Date: 07/01/25

STATE OF OHIO

DEPARTMENT OF ADMINISTRATIVE SERVICES

GENERAL SERVICES DIVISION

OFFICE OF PROCUREMENT SERVICES

4200 SURFACE ROAD, COLUMBUS, OH 43228-1395

MANDATORY USE CONTRACT FOR: TELEHEALTH ADMINISTRATION

CONTRACT NUMBER: CSP900320 EFFECTIVE DATES: 07/01/19 TO 06/30/22

* Renewal through 06/30/26

The Department of Administrative Services has accepted Proposals submitted in response to Request for Proposal (RFP) No.

CSP900020 that opened on 08/29/18. The evaluation of the Proposal responses has been completed. The Offeror listed herein has been determined to be the highest ranking Offeror and has been awarded a Contract for the services listed. The respective Proposal response including, Contract Terms & Conditions, any Proposal amendment, special Contract Terms & Conditions, specifications, pricing schedules and any attachments incorporated by reference and accepted by DAS become a part of this Services Contract.

This Requirements Contract is effective beginning and ending on the dates noted above unless, prior to the expiration date, the Contract is renewed, terminated, or cancelled in accordance with the Contract Terms and Conditions.

This Requirements Contract is available to the Department of Administrative Services (DAS), Human Resources Division (HRD), Office of Benefits Administration as applicable.

The agency is eligible to make purchases of the contracted services in any amount and at any time as determined by the agency. The State makes no representation or guarantee that department will purchase the volume of services as advertised in the Request for Proposal.

This Requirements Contract and any Amendments thereto are available from the DAS Web site at the following address:

www.ohio.gov/procure

* Indicates contract renewal through 06/30/26, per amendment 3.

Eff. Date: 07/01/22

MUTUALLY AGREED TO CLARIFICATIONS / MODIFICATIONS TO THE RFP

Clarifications - response dated 12/06/18 and 01/11/19.

Performance Guarantees – response dated 01/04/19.

*PROHIBITION OF THE EXPENDITURE OF PUBLIC FUND FOR OFFSHORE SERVICES

No State Cabinet Agency, Board or Commission will enter into any contract to purchase services provided outside of the United States or that allows State data to be sent, taken, accessed, tested, maintained, backed-up, stored, or made available remotely outside (located) of the United States, unless a duly signed waiver from the State has been attained.

Notwithstanding any other terms of this Contract, the State reserves the right to recover any funds paid for services the Contractor performs outside of the United States for which it did not receive a waiver. The State does not waive any other rights and remedies provided to the State in the Contract.

Further, no State agency, board, commission, State educational institution, or pension fund will make any purchase from or investment in any Russian institution or company. Notwithstanding any other terms of this Contract, the State reserves the right to recover any funds paid to Contractor for purchases or investments in a Russian institution or company in violation of this paragraph. The provisions of this paragraph will expire when the applicable Executive Order is no longer effective.

The Contractor must complete the Contractor/Subcontractor Affirmation and Disclosure Form affirming the Contractor understands and will meet the requirements of the above prohibition. During the performance of this Contract, if the Contractor changes the location(s) disclosed on the Affirmation and Disclosure Form, Contractor must complete and submit a revised Affirmation and Disclosure Form reflecting such changes.

* Add the Mutually Agreed Upon Modifications, for the Prohibition of the Expenditure of Public Funds for Offshore Services to the contract, effective with all orders on or after 07/01/22.

Eff. Date: 07/01/19

COST SUMMARY

TITLE: TELEHEALTH ADMINISTRATION

RFP NUMBER: CSP900320

UNSPSC CATEGORY CODES: 84130000, 64122100

DESCRIPTION PER EMPLOYEE PER MONTH FEE (PEPM)

Telehealth Administration Fee (PEPM)

$0.42

Eff. Date: 07/01/19

CONTRACTOR INDEX

CONTRACTOR: CONTRACT NO.: CSP900320

OAKS Vendor ID: HR00001368

Community Insurance Co.

Dba Anthem Blue Cross and Blue Shield 6740 North High Street Worthington, OH 43085

CONTRACTOR'S CONTACT: Cindy McCarty Telephone: 614-433-8627 Email: Cindy.McCarty@Anthem.com mailto:Cindy.McCarty@Anthem.com

Eff. Date: 07/01/25

SUMMARY OF AMENDMENTS

Amendment Number

Effective Date Description

3 07/01/25 This amendment is issued to notify that as a result of mutual agreement between the State of Ohio and the contractor, this contract is renewed for an additional twelve months, effective 07/01/25 through 06/30/26. All other prices, terms and conditions remain unchanged.

2 07/01/23

This amendment is issued to notify that as a result of mutual agreement between the State of Ohio and the contractor, this contract is renewed for an additional twenty-four

(24) months, effective 07/01/23 through 06/30/25.

All other prices, terms and conditions remain unchanged.

1 07/01/22

This amendment is issued to notify that as a result of mutual agreement between the State of Ohio and the contractor, this contract is renewed for an additional twelve (12) months, effective 07/01/22 through 06/30/23. Additionally, this amendment is issued to include updated language regarding the Prohibition of the Expenditure of Public Funds for Offshore Services. All other prices, terms and conditions remain unchanged.