BLUE
CROSS
CONTROLLED AFFILIATE LICENSE AGREEMENT
( Includes revisions adopted by Member Plans through their
March 19, 2009 meeting )
This
Agreement by and among Blue Cross and Blue Shield Association
(“BCBSA”) and Triple-S Salud, Inc. (“Controlled
Affiliate”), a Controlled Affiliate of the Blue Cross
Plan(s), known as Triple-S Management Corporation
(“Plan”), which is also a Party signatory
hereto.
WHEREAS,
BCBSA is the owner of the BLUE CROSS and BLUE CROSS Design service
marks;
WHEREAS,
Plan and Controlled Affiliate desire that the latter be entitled to
use the BLUE CROSS and BLUE CROSS Design service marks
(collectively the “Licensed Marks”) as service marks
and be entitled to use the term BLUE CROSS in a trade name
(“Licensed Name”);
NOW
THEREFORE, in consideration of the foregoing and the mutual
agreements hereinafter set forth and for other good and valuable
consideration, the receipt and sufficiency of which are hereby
acknowledged, the parties hereby agree as follows:
Subject
to the terms and conditions of this Agreement, BCBSA hereby grants
to Controlled Affiliate the right to use the Licensed Marks and
Name in connection with, and only in connection with:
(i) health care plans and related services, as defined in
BCBSA’s License Agreement with Plan, and administering the
non-health portion of workers’ compensation insurance, and
(ii) underwriting the indemnity portion of workers’
compensation insurance, provided that Controlled Affiliate’s
total premium revenue comprises less than 15 percent of the
sponsoring Plan’s net subscription revenue.
This grant
of rights is non-exclusive and is limited to the Service Area
served by the Plan. Controlled Affiliate may use the Licensed Marks
and Name in its legal name on the following conditions:
(i) the legal name must be approved in advance, in writing, by
BCBSA; (ii) Controlled Affiliate shall not do business outside
the Service Area under any name or mark; and (iii) Controlled
Affiliate shall not use the Licensed Marks and Name, or any
derivative thereof, as part of any name or symbol used to identify
itself in any securities market. Controlled Affiliate may use the
Licensed Marks and Name in its Trade Name only with the prior,
written, consent of BCBSA.
A. Controlled
Affiliate agrees to use the Licensed Marks and Name only in
connection with the licensed services and further agrees to be
bound by the conditions regarding quality control shown in attached
Exhibit A as they may be amended by BCBSA from
time-to-time.
Amended as
of November 16, 2000
B. Controlled
Affiliate agrees to comply with all applicable federal, state and
local laws.
C. Controlled
Affiliate agrees that it will provide on an annual basis (or more
often if reasonably required by Plan or by BCBSA) a report or
reports to Plan and BCBSA demonstrating Controlled
Affiliate’s compliance with the requirements of this
Agreement including but not limited to the quality control
provisions of this paragraph and the attached
Exhibit A.
D. Controlled
Affiliate agrees that Plan and/or BCBSA may, from time-to-time,
upon reasonable notice, review and inspect the manner and method of
Controlled Affiliate’s rendering of service and use of the
Licensed Marks and Name.
E. As
used herein, a Controlled Affiliate is defined as an entity
organized and operated in such a manner, that it meets the
following requirements:
(1) A
Plan or Plans authorized to use the Licensed Marks in the Service
Area of the Controlled Affiliate pursuant to separate License
Agreement(s) with BCBSA, other than such Controlled
Affiliate’s License Agreement(s), (the “Controlling
Plan(s)”), must have the legal authority directly or
indirectly through wholly-owned subsidiaries to select members of
the Controlled Affiliate’s governing body having not less
than 50% voting control thereof and to:
(a) prevent
any change in the articles of incorporation, bylaws or other
establishing or governing documents of the Controlled Affiliate
with which the Controlling Plan(s) do(es) not concur;
(b) exercise
control over the policy and operations of the Controlled Affiliate
at least equal to that exercised by persons or entities (jointly or
individually) other than the Controlling Plan(s); and
Notwithstanding
anything to the contrary in (a) through (b) hereof, the
Controlled Affiliate’s establishing or governing documents
must also require written approval by the Controlling Plan(s)
before the Controlled Affiliate can:
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(i)
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change its legal and/or trade
names;
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(ii)
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change the geographic area in which
it operates;
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(iii)
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change any of the type(s) of
businesses in which it engages;
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(iv)
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create, or become liable for by way
of guarantee, any indebtedness, other than indebtedness arising in
the ordinary course of business;
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(v)
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sell any assets, except for sales in
the ordinary course of business or sales of equipment no longer
useful or being replaced;
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(vi)
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make any loans or advances except in
the ordinary course of business;
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(vii)
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enter into any arrangement or
agreement with any party directly or indirectly affiliated with any
of the owners or persons or entities with the authority to select
or appoint members or board members of the Controlled Affiliate,
other than the Plan or Plans (excluding owners of stock holdings of
under 5% in a publicly traded Controlled Affiliate);
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(viii)
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conduct any business other than
under the Licensed Marks and Name;
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(ix)
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take any action that any Controlling
Plan or BCBSA reasonably believes will adversely affect the
Licensed Marks and Name.
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In
addition, a Plan or Plans directly or indirectly through wholly
owned subsidiaries shall own at least 50% of any for-profit
Controlled Affiliate.
(2) A
Plan or Plans authorized to use the Licensed Marks in the Service
Area of the Controlled Affiliate pursuant to separate License
Agreement(s) with BCBSA, other than such Controlled
Affiliate’s License Agreement(s), (the “Controlling
Plan(s)”), have the legal authority directly or indirectly
through wholly-owned subsidiaries to select members of the
Controlled Affiliate’s governing body having more than 50%
voting control thereof and to:
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(a)
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prevent any change in the articles
of incorporation, bylaws or other establishing or governing
documents of the Controlled Affiliate with which the Controlling
Plan(s) do(es) not concur;
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(b)
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exercise control over the policy and
operations of the Controlled Affiliate.
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In
addition, a Plan or Plans directly or indirectly through
wholly-owned subsidiaries shall own more than 50% of any for-profit
Controlled Affiliate.
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A. Controlled
Affiliate recognizes the importance of a comprehensive national
network of independent BCBSA licensees which are committed to
strengthening the Licensed Marks and Name. The Controlled Affiliate
further recognizes that its actions within its Service Area may
affect the value of the Licensed Marks and Name
nationwide.
B. Controlled
Affiliate shall at all times make proper service mark use of the
Licensed Marks and Name, including but not limited to use of such
symbols or words as BCBSA shall specify to protect the Licensed
Marks and Name and shall comply with such rules (generally
applicable to Controlled Affiliates licensed to use the Licensed
Marks and Name) relative to service mark use, as are issued from
time-to-time by BCBSA. Controlled Affiliate recognizes and agrees
that all use of the Licensed Marks and Name by Controlled Affiliate
shall inure to the benefit of BCBSA.
C. Controlled
Affiliate may not directly or indirectly use the Licensed Marks and
Name in a manner that transfers or is intended to transfer in the
Service Area the goodwill associated therewith to another mark or
name, nor may Controlled Affiliate engage in activity that may
dilute or tarnish the unique value of the Licensed Marks and
Name.
D. If
Controlled Affiliate meets the standards of 2E(1) but not 2E(2)
above and any of Controlled Affiliate’s advertising or
promotional material is reasonably determined by BCBSA and/or the
Plan to be in contravention of rules and regulations governing the
use of the Licensed Marks and Name, Controlled Affiliate shall for
ninety (90) days thereafter obtain prior approval from BCBSA
of advertising and promotional efforts using the Licensed Marks and
Name, approval or disapproval thereof to be forthcoming within five
(5) business days of receipt of same by BCBSA or its designee.
In all advertising and promotional efforts, Controlled Affiliate
shall observe the Service Area limitations applicable to
Plan.
C. Notwithstanding
any other provision in the Plan’s License Agreement with
BCBSA or in this Agreement, Controlled Affiliate shall use its best
efforts to promote and build the value of the Licensed Marks and
Name.
Amended as
of June 16, 2005
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4. SUBLICENSING AND ASSIGNMENT
Controlled
Affiliate shall not, directly or indirectly, sublicense, transfer,
hypothecate, sell, encumber or mortgage, by operation of law or
otherwise, the rights granted hereunder and any such act shall be
voidable at the sole option of Plan or BCBSA. This Agreement and
all rights and duties hereunder are personal to Controlled
Affiliate.
Controlled
Affiliate shall promptly notify Plan and Plan shall promptly notify
BCBSA of any suspected acts of infringement, unfair competition or
passing off that may occur in relation to the Licensed Marks and
Name. Controlled Affiliate shall not be entitled to require Plan or
BCBSA to take any actions or institute any proceedings to prevent
infringement, unfair competition or passing off by third parties.
Controlled Affiliate agrees to render to Plan and BCBSA, without
charge, all reasonable assistance in connection with any matter
pertaining to the protection of the Licensed Marks and Name by
BCBSA.
6. LIABILITY INDEMNIFICATION
Controlled
Affiliate and Plan hereby agree to save, defend, indemnify and hold
BCBSA harmless from and against all claims, damages, liabilities
and costs of every kind, nature and description (except those
arising solely as a result of BCBSA’s negligence) that may
arise as a result of or related to Controlled Affiliate’s
rendering of services under the Licensed Marks and Name.
A. Except
as otherwise provided herein, the license granted by this Agreement
shall remain in effect for a period of one (1) year and shall
be automatically extended for additional one (1) year periods
unless terminated pursuant to the provisions herein.
B. This
Agreement and all of Controlled Affiliate’s rights hereunder
shall immediately terminate without any further action by any party
or entity in the event that: (i) the Plan ceases to be
authorized to use the Licensed Marks and Name; or
(ii) pursuant to Paragraph 15(a)(x) of the Blue Cross
License Agreement the Plan ceases to be authorized to use the
Licensed Names and Marks in the geographic area served by the
Controlled Affiliate provided, however, that if the Controlled
Affiliate is serving more than one State or portions thereof, the
termination of this Agreement shall be limited to the State(s) or
portions thereof in which the Plan’s license to use the
Licensed Marks and Names is terminated. By not appealing or
challenging such regulatory action within the time prescribed by
law or regulation, and in any event no later than 120 days
after such action is taken, a Plan shall be deemed to have
exhausted its rights to appeal or challenge, and automatic
termination shall proceed.
Amended as
of September 14, 2004
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C. Notwithstanding
any other provision of this Agreement, this license to use the
Licensed Marks and Name may be forthwith terminated by the Plan or
the affirmative vote of the majority of the Board of Directors of
BCBSA present and voting at a special meeting expressly called by
BCBSA for the purpose on ten (10) days written notice to the
Plan advising of the specific matters at issue and granting the
Plan an opportunity to be heard and to present its response to the
Board for: (1) failure to comply with any applicable minimum
capital or liquidity requirement under the quality control
standards of this Agreement; or (2) failure to comply with the
“Organization and Governance” quality control standard
of this Agreement; or (3) impending financial insolvency; or
(4) for a Smaller Controlled Affiliate (as defined in
Exhibit A), failure to comply with any of the applicable
requirements of Standards 2, 3, 4, 5 or 7 of attached
Exhibit A; or (5) the pendency of any action instituted
against the Controlled Affiliate seeking its dissolution or
liquidation of its assets or seeking appointment of a trustee,
interim trustee, receiver or other custodian for any of its
property or business or seeking the declaration or establishment of
a trust for any of its property or business, unless this Controlled
Affiliate License Agreement has been earlier terminated under
paragraph 7(e); or (6) failure by a Controlled Affiliate that
meets the standards of 2E(1) but not 2E(2) above to obtain
BCBSA’s written consent to a change in the identity of any
owner, in the extent of ownership, or in the identity of any person
or entity with the authority to select or appoint members or board
members, provided that as to publicly traded Controlled Affiliates
this provision shall apply only if the change affects a person or
entity that owns at least 5% of the Controlled Affiliate’s
stock before or after the change; or (7) such other reason as
is determined in good faith immediately and irreparably to threaten
the integrity and reputation of BCBSA, the Plans, any other
licensee including Controlled Affiliate and/or the Licensed Marks
and Name.
D. Except
as otherwise provided in Paragraphs 7(B), 7(C) or 7(E) herein,
should Controlled Affiliate fail to comply with the provisions of
this Agreement and not cure such failure within thirty
(30) days of receiving written notice thereof (or commence a
cure within such thirty day period and continue diligent efforts to
complete the cure if such curing cannot reasonably be completed
within such thirty day period) BCBSA or the Plan shall have the
right to issue a notice that the Controlled Affiliate is in a state
of noncompliance. If a state of noncompliance as aforesaid is
undisputed by the Controlled Affiliate or is found to exist by a
mandatory dispute resolution panel and is uncured as provided
above, BCBSA shall have the right to seek judicial enforcement of
the Agreement or to issue a notice of termination thereof.
Notwithstanding any other provisions of this Agreement, any
disputes as to the termination of this License pursuant to
Paragraphs 7(B), 7(C) or 7(E) of this Agreement shall not be
subject to mediation and mandatory dispute resolution. All other
disputes between BCBSA, the Plan and/or Controlled Affiliate shall
be submitted promptly to mediation and mandatory dispute
resolution. The mandatory dispute resolution panel shall have
authority to issue orders for specific performance and assess
monetary penalties. Except, however, as provided in Paragraphs 7(B)
and 7(E) of this Agreement, this license to use the Licensed Marks
and Name may not be finally terminated for any reason without the
affirmative vote of a majority of the present and voting members of
the Board of Directors of BCBSA.
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E. This
Agreement and all of Controlled Affiliate’s rights hereunder
shall immediately terminate without any further action by any party
or entity in the event that:
(1) Controlled
Affiliate shall no longer comply with item 2(E) above;
(2) Appropriate
dues, royalties and other payments for Controlled Affiliate
pursuant to paragraph 9 hereof, which are the royalties for this
License Agreement, are more than sixty (60) days in arrears to
BCBSA; or
(3) Any
of the following events occur: (i) a voluntary petition shall
be filed by Controlled Affiliate seeking bankruptcy,
reorganization, arrangement with creditors or other relief under
the bankruptcy laws of the United States or any other law governing
insolvency or debtor relief, or (ii) an involuntary petition
or proceeding shall be filed against Controlled Affiliate seeking
bankruptcy, reorganization, arrangement with creditors or other
relief under the bankruptcy laws of the United States or any other
law governing insolvency or debtor relief and such petition or
proceeding is consented to or acquiesced in by Controlled Affiliate
or is not dismissed within sixty (60) days of the date upon
which the petition or other document commencing the proceeding is
served upon the Controlled Affiliate, or (iii) an order for
relief is entered against Controlled Affiliate in any case under
the bankruptcy laws of the United States, or Controlled Affiliate
is adjudged bankrupt or insolvent as those terms are defined in the
Uniform Commercial Code as enacted in the State of Illinois by any
court of competent jurisdiction, or (iv) Controlled Affiliate
makes a general assignment of its assets for the benefit of
creditors, or (v) any government or any government official,
office, agency, branch, or unit assumes control of Controlled
Affiliate or delinquency proceedings (voluntary or involuntary) are
instituted, or (vi) an action is brought by Controlled
Affiliate seeking its dissolution or liquidation of its assets or
seeking the appointment of a trustee, interim trustee, receiver or
other custodian for any of its property or business, or
(vii) an action is instituted by any governmental entity or
officer against Controlled Affiliate seeking its dissolution or
liquidation of its assets or seeking the appointment of a trustee,
interim trustee, receiver or other custodian for any of its
property or business and such action is consented to or acquiesced
in by Controlled Affiliate or is not dismissed within one hundred
thirty (130) days of the date upon which the pleading or other
document commencing the action is served upon the Controlled
Affiliate, provided that if the action is stayed or its prosecution
is enjoined, the one hundred thirty (130) day period is tolled
for the duration of the stay or injunction, and provided further,
that the Association’s Board of Directors may toll or extend
the 130 day period at any time prior to its expiration, or
(viii) a trustee, interim trustee, receiver or other custodian
for any of Controlled Affiliate’s property or business is
appointed or the Controlled Affiliate is ordered dissolved or
liquidated. Notwithstanding any other provision of this Agreement,
a declaration or a request for declaration of the existence of a
trust over any of the Controlled Affiliate’s property or
business shall not in itself be deemed to constitute or seek
appointment of a trustee, interim trustee, receiver or other
custodian for purposes of subparagraphs 7(e)(3)(vii) and
(viii) of this Agreement
Amended as
of March 18, 2004
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F. Upon
termination of this Agreement for cause or otherwise, Controlled
Affiliate agrees that it shall immediately discontinue all use of
the Licensed Marks and Name, including any use in its trade
name.
G. Upon
termination of this Agreement, Controlled Affiliate shall
immediately notify all of its customers that it is no longer a
licensee of BCBSA and, if directed by the Association’s Board
of Directors, shall provide instruction on how the customer can
contact BCBSA or a designated licensee to obtain further
information on securing coverage. The notification required by this
paragraph shall be in writing and in a form approved by BCBSA. The
BCBSA shall have the right to audit the terminated entity’s
books and records to verify compliance with this
paragraph.
H. In
the event this Agreement terminates pursuant to 7(b) hereof, or in
the event the Controlled Affiliate is a Larger Controlled Affiliate
(as defined in Exhibit A), upon termination of this Agreement,
the provisions of Paragraph 7.G. shall not apply and the
following provisions shall apply, except that, in the event of a
partial termination of this Agreement pursuant to
Paragraph 7(B)(ii) of this Agreement, the notices, national
account listing, payment, and audit right listed below shall be
applicable solely with respect to the geographic area for which the
Plan’s license to use the Licensed Names and Marks is
terminated:
(1) The
Controlled Affiliate shall send a notice through the U.S. mails,
with first class postage affixed, to all individual and group
customers, providers, brokers and agents of products or services
sold, marketed, underwritten or administered by the Controlled
Affiliate under the Licensed Marks and Name. The form and content
of the notice shall be specified by BCBSA and shall, at a minimum,
notify the recipient of the termination of the license, the
consequences thereof, and instructions for obtaining alternate
products or services licensed by BCBSA, subject to any conflicting
state law and state regulatory requirements. This notice shall be
mailed within 15 days after termination.
(2) The
Controlled Affiliate shall deliver to BCBSA within five days of a
request by BCBSA a listing of national accounts in which the
Controlled Affiliate is involved (in a control, participating or
servicing capacity), identifying the national account and the
Controlled Affiliate’s role therein.
(3) Unless
the cause of termination is an event respecting BCBSA stated in
paragraph 15(a) or (b) of the Plan’s license agreement
with BCBSA to use the Licensed Marks and Name, the Controlled
Affiliate, the Plan, and any other Licensed Controlled Affiliates
of the Plan shall be jointly liable for payment to BCBSA of an
amount equal to the Re-Establishment Fee (described below)
multiplied by the number of Licensed Enrollees of the Controlled
Affiliate; provided that if any other Plan is permitted by BCBSA to
use marks or names licensed by BCBSA in the Service Area
established by this Agreement, the Re-Establishment Fee shall be
multiplied by a fraction, the numerator of which is the number of
Licensed Enrollees of the Controlled Affiliate, the Plan, and any
other Licensed Controlled Affiliates and the denominator of which
is the total number of Licensed Enrollees in the Service
Area.
Amended as
of June 16, 2005
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The
Re-Establishment Fee shall be indexed to a base fee of $80. The
Re-Establishment Fee through December 31, 2005 shall be $80.
The Re-establishment Fee for calendar years after December 31,
2005 shall be adjusted on January 1 of each calendar year up to and
including January 1, 2010 and shall be the base fee multiplied
by 100% plus the cumulative percentage increase or decrease in the
Plans’ gross administrative expense (standard BCBSA
definition) per Licensed Enrollee since December 31, 2004. The
adjustment shall end on January 1, 2011, at which time the
Re-Establishment Fee shall be fixed at the then-current amount and
no longer automatically adjusted. For example, if the Plans’
gross administrative expense per Licensed Enrollee was $278.60,
$285.00 and $290.00 for calendar year end 2004, 2005 and 2006,
respectively, the January 1, 2007 Re-Establishment Fee would
be $83.27 (100% of base fee plus $1.84 for calendar year 2005 and
$1.43 for calendar year 2006). Licensed Enrollee means each and
every person and covered dependent who is enrolled as an individual
or member of a group receiving products or services sold, marketed
or administered under marks or names licensed by BCBSA as
determined at the earlier of (i) the end of the last fiscal
year of the terminated entity which ended prior to termination or
(ii) the fiscal year which ended before any transactions
causing the termination began. Notwithstanding the foregoing, the
amount payable pursuant to this subparagraph H. (3) shall be
due only to the extent that, in BCBSA’s opinion, it does not
cause the net worth of the Controlled Affiliate, the Plan or any
other Licensed Controlled Affiliates of the Plan to fall below 100%
of the Health Risk-Based Capital formula, or its equivalent under
any successor formula, as set forth in the applicable financial
responsibility standards established by BCBSA (provided such
equivalent is approved for purposes of this sub paragraph by the
affirmative vote of three-fourths of the Plans and three-fourths of
the total then current weighted vote of all the Plans); measured as
of the date of termination, and adjusted for the value of any
transactions not made in the ordinary course of business. This
payment shall not be due in connection with transactions
exclusively by or among Plans or their affiliates, including
reorganizations, combinations or mergers, where the BCBSA Board of
Directors determines that the license termination does not result
in a material diminution in the number of Licensed Enrollees or the
extent of their coverage. At least 50% of the Re-Establishment Fee
shall be awarded to the Plan (or Plans) that receive the new
license(s) for the service area(s) at issue; provided, however,
that such award shall not become due or payable until all disputes,
if any, regarding the amount of and BCBSA’s right to such
Re-Establishment Fee have been finally resolved; and provided
further that the award shall be based on the final amount actually
received by BCBSA. The Board of Directors shall adopt a resolution
which it may amend from time to time that shall govern
BCBSA’s use of its portion of the award. In the event that
the Controlled Affiliate’s license is reinstated by BCBSA or
is deemed t
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