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AGREEMENT between HEWLETT‐PACKARD COMPANY and INSURE OKLAHOMA - page 1 / 4

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AGREEMENT between HEWLETTPACKARD COMPANY and INSURE OKLAHOMA

Hewlett-Packard Company, (hereinafter referred to as “HP”) and ________________________________________ (hereinafter referred to as “EMPLOYER”) enter into this Agreement: (Print Employer’s Name)

ARTICLE I. PURPOSE

1.0

The purpose of this Agreement is for HP and EMPLOYER to contract for subsidy payments to assist in purchasing group health coverage for employees under the INSURE OKLAHOMA program. The parties agree and understand that the INSURE OKLAHOMA Program is a federal matching program and that funds are paid from federal and state treasury funds.

ARTICLE II. THE PARTIES

2.0

Hewlett-Packard Co. (HP) (a) HP is contracted by the Oklahoma Health Care Authority (OHCA) to provide third party administrator services (as

2.1

defined) for INSURE OKLAHOMA. OHCA is the state agency that the Oklahoma Legislature has designated to administer Oklahoma’s INSURE OKLAHOMA program. NAME ______________________________________________________________

(Print EMPLOYER’s Name) (a) EMPLOYER certifies it is a legal business entity that qualifies for participation under INSURE OKLAHOMA rules

found at OAC 317:45-7-1. (b) EMPLOYER has authority to enter into this Agreement pursuant to its organizational documents, bylaws, or properly

enacted resolution of its governing authority. The person executing this Agreement for EMPLOYER has

authority

2.2

to execute this Agreement on EMPLOYER’s behalf pursuant to EMPLOYER’s bylaws, or properly enacted resolution of EMPLOYER’s governing authority. ADDRESSES The parties agree that the mailing addresses for the parties to this Agreement are as follows:

organizational

documents,

HP mailing address:

EMPLOYER mailing address:

Premium Assistance HP Attention: Employer Specialists 2401 NW 23rd, Suite 11 Oklahoma City, OK 73107

______________________________________

______________________________________

ARTICLE III. TERM

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3.1

This Agreement shall be effective starting the first day of _____________________ automatically renew every twelve (12) months thereafter, so long as the employer qualifies for participation under INSURE OKLAHOMA rules found at OAC 317:45-7-1. EMPLOYER shall not assign or transfer any rights, duties, or obligations under this Agreement without HP/OHCA’s prior written consent. (the “Effective Date”) and will

ARTICLE IV. SCOPE OF AGREEMENT

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EMPLOYER RESPONSIBILITIES EMPLOYER agrees to:

  • (a)

    Provide group coverage to certain employees through one or more INSURE OKLAHOMA qualifying health plan(s) as defined by OAC 317:45-5-1.

  • (b)

    Provide INSURE OKLAHOMA forms and information received from HP/OHCA to its employees on a timely basis and

to inform them of their option to apply for the INSURE OKLAHOMA program.

  • (c)

    Pay all invoices for group health plan(s) chosen by employees participating in INSURE OKLAHOMA by the due date specified by the carrier (including any allowable grace period).

  • (d)

    Pay no less than 25% of the health plan premium for employees participating in INSURE OKLAHOMA. This minimum amount for each participating employee can be found on the “Employee Approved–Inform Employer Letter” PMS-9003-D.

  • (e)

    Withhold a premium from an employee’s paycheck as shown in the “Employee Approved –Inform Employer Letter” PMS-9003-D of:

    • no more than 15% of the applicable premium for any employee participating in INSURE OKLAHOMA.

    • no more than 15% of the applicable premium for the employee’s spouse if EMPLOYER offers coverage for spouses and an employee’s spouse participates in INSURE OKLAHOMA.

  • (f)

    Provide written notification to HP/OHCA on the INSURE OKLAHOMA-4 (Small Business Employer Change Form) within five days from the effective date of

    • any change in the employment status of any employee participating in INSURE OKLAHOMA, for example employee’s termination

Insure Oklahoma/HP/Employer Contract 7-8-11

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