DAS003_CSP900020_Amendment_5.pdf

Index No.: DAS003 Contract No.: CSP900020 Eff. Date: 09/01/23

STATE OF OHIO

DEPARTMENT OF ADMINISTRATIVE SERVICES

GENERAL SERVICES DIVISION

OFFICE OF PROCUREMENT SERVICES

4200 SURFACE ROAD, COLUMBUS, OH 43228-1395

AMENDMENT FOR CHANGE

AMENDMENT NO. 5

TO: LIMITED DISTRIBUTION – DEPARTMENT OF ADMINISTRATIVE SERVICES

FROM: KATHLEEN C. MADDEN, DIRECTOR, DEPARTMENT OF ADMINISTRATIVE SERVICES

SUBJECT: CONTRACT FOR MEDICAL THIRD-PARTY ADMINISTRATOR (TPA)

Attached are pages 2 and 5 to this contract. Remove these pages from the existing contract and replace with the attached pages on the effective date.

This amendment is issued to incorporate the revised Anthem Blue Cross Blue Shield’s Discount Guarantees into the contract by mutual agreement between Anthem Blue Cross Blue Shield and the State of Ohio, effective for the contract year beginning 07/01/22.

All other prices, terms and conditions remain unchanged.

This Amendment, the main Requirements Contract and any additional amendments thereto are available from the DAS Web site at the following address:

http://www.ohio.gov/procure

Affected Contractor(s):

Medical Mutual of Ohio dba Medical Mutual Services LLC 10 W. Broad St. Suite 1400 Columbus, OH 43215

Community Insurance Co.

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

MUTUALLY AGREED TO CLARIFICATIONS / MODIFICATIONS TO THE RFP

ANTHEM

Clarifications - response dated 10/10/18, 11/09/18

Finalist Interview, & acceptance to final terms - response dated 10/26/18 and 11/15/18

Performance Guarantees – response dated 11/05/18

Best and Final Offer - response dated 10/26/18

*State of Ohio Network PG_ASO_Dayton region FY2023 FINAL – 06/23/2023

*State of Ohio Network PG_Cincinnati FY2023 FINAL – 06/23/2023

*State of Ohio Network PG_Southern FY2023 FINAL – 06/23/2023

*State of Ohio Network PG_Youngstown FY2023 FINAL – 06/23/2023

*Anthem Discount Language 042523 FY24 – 06/22/2023

*Final State of Ohio Network Guarantees FY24 – 06/22/2023

MEDICAL MUTUAL

Clarifications - response dated 10/08/18

Finalist Interview, & acceptance to final terms - response dated 10/26/18

Best and Final Offer - response dated 10/26/18

State of Ohio Discount Guarantee MMO FY23 FY26 Proposal 04282023 – response dated 06/08/23

*Indicates the mutual agreement for the Discount Guarantees that will apply for Anthem for the periods of FY23 through FY24.

SUMMARY OF AMENDMENTS

Amendment Number

Effective Date Description

5 09/01/23

This amendment is issued to incorporate the revised Anthem Blue Cross Blue Shield’s Discount Guarantees into the contract by mutual agreement between Anthem Blue Cross Blue Shield and the State of Ohio, effective for the contract year beginning 07/01/22.

4 07/07/23 This amendment is issued to incorporate the revised Medical Mutual Services’ Discount Guarantee into the contract by mutual agreement between Medical Mutual Services’ and the State of Ohio, effective for the contract year beginning 07/01/22.

3 02/26/21

This amendment is issued to incorporate Anthem Blue Cross Blue Shield’s Discount Audit Guarantee into the contract and revise Medical Mutual Services’ Discount Audit Guarantee, effective 07/01/19. Both Anthem Blue Cross Blue Shield’s and Medical Mutual Services’ Discount Audit Guarantee are firm 07/01/19 through 06/30/22, with an opportunity to negotiate for the contract year beginning 07/01/22.

2 09/18/20

This amendment is issued to notify that as a result of mutual agreement between the state of Ohio and the Contractor, Anthem Blue Cross and Blue Shield, this contract is renewed for an additional 48 months, effective 07/01/22 through 06/30/26. Anthem’s administrative fee for the renewal period has been added, effective with all orders issued on or after 07/01/22.

1 08/07/20

This amendment is issued to adjust Medical Mutual of Ohio’s administrative fee, effective with all orders issued on or after 07/01/2020.

Additionally, this amendment is issued to notify that as a result of mutual agreement between the state of Ohio and the Contractor, Medical Mutual of Ohio, this contract is renewed for an additional 48 months, effective 07/01/22 through 06/30/26.

SUMMARY OF AMENDMENTS