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?.w:.. ? Medical Mutual Services' agreement or arrangement with that vendor may not include the vendor's purchase price from the Provider, but may be based on some other financial arrangement such as a guaranteed discount. The Paid Claim Amounts, in these circumstances, will be based on the network's re-pricing agreement with the vendor and not upon the vendor's actual purchase price with the Provider, subject to any further conditions or limitations set forth herein. Vendors include, but are not limited to, pharmacy providers, other rnanaged care providers, home health providers and other provider networks. (v) When the Covered Person receives services outside of the State of Ohio the claims for Covered Services will be processed whenever possible through a vendor relationship with another provider network with which Medical Mutual Services has contracted. The Paid Claim Amount for a claim submitted by an out of state provider will be based on the contractual arrangement the provider has with the network program. If the Plan's primary network does not have an arrangemen# with the provider, MMS will attempt to arrange for a discount through a secondary network. In such cases, any fees to obtain the discount will be included in the Paid Claim Amount. If there is no Agreement with a network provider the Paid Claim Amount will be based on Net Covered Charges. The Plan Sponsor shall not be entitled to any further reduction or adjustment in the price of the claim other than what Medical Mutual Services receives from the network program. F. Covered Charqes: the charges for Covered Services, as defined in the applicable Benefits Book(s) . G. Net Covered Charges: Covered Charges less any deductibles, copayments, coinsurance or other patient liabilities and any amounts paid by other parties resulting from coordination of benefits, subrogation, workers' compensation and other party liability. H. Administrative Fee: The monthly amount paid to Medical Mutual Services by the Plan Sponsor to cover administrative and other expenses per Participant per month. The Administrative Fee is specified in Exhibit A. Provider Discount: Net Covered Charges minus the Paid Claim Amount. J. Out of State Surcharqes: The States of New York and Massachusetts have enacted legislation which imposes surcharges on certain health care costs incurred by Covered Persons receiving services in those states. Medical Mutual Services will pay the Out of State Surcharges directly tg each state for the Plan Sponsor. The Plan Sponsor will be invoiced for actual Out of 5tate Surcharges paid by Medical Mutual Services as defined in Section 2B. No additional Administrative Fee will be charged for this service. The same procedure will apply if other states pass similar legislation. Page 2 Rev. 090102 03eCityofNorthOlmstedDRub