BLUE SHIELD LICENSE AGREEMENT
(Includes revisions, if any, adopted by Member Plans through their
November 13, 2008 meeting)
This agreement by
and between Blue Cross and Blue Shield Association
(“BCBSA”) and The Blue Shield Plan, known as
(the “Plan”).
WHEREAS, the Plan
and/or its predecessor(s) in interest (collectively the
“Plan”) had the right to use the BLUE SHIELD and BLUE
SHIELD Design service marks (collectively the “Licensed
Marks”) for health care plans in its service area, which was
essentially local in nature;
WHEREAS, the Plan
was desirous of assuring nationwide protection of the Licensed
Marks, maintaining uniform quality controls among Plans,
facilitating the provision of cost effective health care services
to the public and otherwise benefiting the public;
WHEREAS, to better
attain such ends, the Plan and the predecessor of BCBSA executed
the Agreement(s) Relating to the Collective Service Mark
“Blue Shield”; and
WHEREAS, BCBSA and
the Plan desire to supercede said Agreement(s) to reflect their
current practices and to assure the continued integrity of the
Licensed Marks and of the BLUE SHIELD system;
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 agree as follows:
1. BCBSA
hereby grants to the Plan, upon the terms and conditions of this
License Agreement, the right to use BLUE SHIELD in its trade and/or
corporate name (the “Licensed Name”), and the right to
use the Licensed Marks, in the sale, marketing and administration
of health care plans and related services in the Service Area set
forth and defined in paragraph 5 below. As used herein, health care
plans and related services shall include acting as a nonprofit
health care plan, a for-profit health care plan, or mutual health
insurer operating on a not-for-profit or for-profit basis, under
state law; financing access to health care services; when working
with a bank that holds the relevant license to use the Licensed
Name and Marks, offering: (i) tax-favored savings accounts for
medical expenses and means for accessing such accounts, such as
debit cards or checks, that are provided solely to support access
to such tax-favored savings accounts, all pursuant to such license,
or (ii) prepaid rewards cards that are provided for completion
of a wellness program, all pursuant to such license; providing
health care management and administration; administering, but not
underwriting, non-health portions of Worker’s Compensation
insurance; and delivering health care services, except hospital
services (as defined in the Guidelines to Membership Standards
Applicable to Regular Members).
2. The Plan
may use the Licensed Marks and Name in connection with the offering
of: a) health care plans and related services in the Service Area
through Controlled Affiliates, provided that each such Controlled
Affiliate is separately licensed to use the Licensed Marks and Name
under the terms and conditions contained in the Agreement attached
as Exhibit 1 hereto (the “Controlled Affiliate License
Agreement”); and: b) insurance coverages offered by life
insurers under the applicable law in the Service Area, other than
those which the Plan may offer in its own name, provided through
Controlled Affiliates, provided that each such Controlled Affiliate
is separately licensed to use the Licensed Marks and Name under the
terms and conditions contained in the Agreement attached as
Exhibit 1A hereto (the “Controlled Affiliate License
Agreement Applicable to Life Insurance Companies”) and
further provided that the offering of such services does not and
will not dilute or tarnish the unique value of the Licensed Marks
and Name; and c) administration and underwriting of Workers’
Compensation Insurance Controlled Affiliates, provided that each
such Controlled Affiliate is separately licensed to use the
Licensed Marks and Name under the terms and conditions contained in
the Agreement attached as Exhibit 1 hereto (the
“Controlled Affiliate License.”); and d) regional
Medicare Advantage PPO Products in cooperation with one or more
other Plans through jointly-held Controlled Affiliates, provided
that each such Controlled Affiliate is separately licensed to use
the Licensed Marks and Name under the terms and conditions
contained in the Agreement attached as Exhibit 1B hereto (the
“Controlled Affiliate License Agreement Applicable to
Regional Medicare Advantage PPO Products”); and e) regional
Medicare Part D Prescription Drug Plan products in cooperation
with one or more other Plans through jointly-held Controlled
Affiliates, provided that each such Controlled Affiliate is
separately licensed to use the Licensed Marks and Name under the
terms and conditions contained in the Agreement attached as
Exhibit 1C hereto (the “Controlled Affiliate License
Agreement Applicable to Regional Medicare Part D Prescription
Drug Plan Products”). As used herein, a Controlled Affiliate
is defined as an entity organized and operated in such a manner
that it is subject to the bona fide control of a Plan or Plans and,
if the entity meets the standards of subparagraph B but not
subparagraph A of this paragraph, the entity, its owners, and
persons with authority to select or appoint members or board
members, other than a Plan or Plans, have received written approval
of BCBSA. Absent written approval by BCBSA of an alternative method
of control, bona fide control with respect to the Controlled
Affiliate Licenses authorized in clauses a) through c) of this
Paragraph 2 shall mean that a Plan or Plans authorized to use
the Licensed Marks in the Service Area of the Controlled Affiliate
pursuant to this License Agreement(s) with BCBSA, other than such
Controlled Affiliate’s License Agreement(s), (for purposes of
subparagraphs 2.A. and 2.B., the “Controlling
Plan(s)”), must have:
Amended as of September 18,
2008
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A.
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The
legal authority, directly or indirectly through wholly-owned
subsidiaries: (a) to select members of the Controlled
Affiliate’s governing body having more than 50% voting
control thereof; (b) to exercise control over the policy and
operations of the Controlled Affiliate ; (c) to 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. In addition,
a Plan or Plans directly or indirectly through wholly-owned
subsidiaries shall own more than 50% of any for-profit Controlled
Affiliate; or
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B.
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The
legal authority directly or indirectly through wholly-owned
subsidiaries (a) to select members of the Controlled
Affiliate’s governing body having not less than 50% voting
control thereof; (b) to 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; (c) to 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). Notwithstanding anything to the
contrary in (a) through (c) 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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1. Change its
legal and/or trade name;
2. Change the
geographic area in which it operates;
3. Change any
of the types of businesses in which it engages;
4. Create, or
become liable for by way of guarantee, any indebtedness, other than
indebtedness arising in the ordinary course of business;
5. Sell any
assets, except for sales in the ordinary course of business or
sales of equipment no longer useful or being replaced;
6. Make any
loans or advances except in the ordinary course of
business;
7. Enter into
any arrangement or agreement with any party directly or indirectly
affiliated with any of the owners of the Controlled Affiliate 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);
8. Conduct any
business other than under the Licensed Marks and Name;
Amended as of June 11, 1998
-2-
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9.
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Take any action that any Controlling
Plan or BCBSA reasonably believes will adversely affect the
Licensed Marks or Names.
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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. With respect to the Controlled Affiliate License
Agreements authorized in clauses d) and e) of this
Paragraph 2, and absent written approval by BCBSA of an
alternative method of control, bona fide control shall mean that
the Controlled Affiliate is organized and operated in such a manner
that it meets the following requirements:
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C.
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The
Controlled Affiliate is owned or controlled by two or more Plans
authorized to use the Licensed Marks pursuant to this License
Agreement with BCBSA (for purposes of this subparagraph 2.C.
through subparagraph 2.E., the “Controlling
Plans”);
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D.
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Each Controlling Plan is authorized
pursuant to this Agreement to use the Licensed Marks in a
geographic area in the Region (as that term is defined in such
Controlled Affiliate License Agreements) and every geographic area
in the Region is so licensed to at least one of the Controlling
Plans; and
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E.
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The
Controlling Plans must have the legal authority directly or
indirectly through wholly-owned subsidiaries (a) to select
members of the Controlled Affiliate’s governing body having
not less than 100% voting control thereof; (b) to prevent any
change in the articles of incorporation, bylaws or other
establishing or governing documents of the Controlled Affiliate
with which the Controlling Plans do not concur; and (c) to
exercise control over the policy and operations of the Controlled
Affiliate. Notwithstanding anything to the contrary in
(a) through (c) of this subparagraph E., the Controlled
Affiliate’s establishing or governing documents must also
require written approval by each of the Controlling Plans before
the Controlled Affiliate can:
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1.
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Change its legal and/or trade
names;
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2.
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Change the geographic area in which
it operates (except such approval shall not be required with
respect to business of the Controlled Affiliate conducted under the
Licensed Marks within the Service Area of one of the Controlling
Plans pursuant to a separate controlled affiliate license agreement
with BCBSA sponsored by such Controlling Plan);
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Amended as of March 17,
2005
(The next page is page
3)
-2a-
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3.
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Change any of the type(s) of
businesses in which it engages (except such approval shall not be
required with respect to business of the Controlled Affiliate
conducted under the Licensed Marks within the Service Area of one
of the Controlling Plans pursuant to a separate controlled
affiliate license agreement with BCBSA sponsored by such
Controlling Plan);
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4.
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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,
the Controlling Plans directly or indirectly through wholly- owned
subsidiaries shall own 100% of any for-profit Controlled
Affiliate.
3. The Plan
may engage in activities not required by BCBSA to be directly
licensed through Controlled Affiliates and may indicate its
relationship thereto by use of the Licensed Name as a tag line,
provided that the engaging in such activities does not and will not
dilute or tarnish the unique value of the Licensed Marks and Name
and further provided that such tag line use is not in a manner
likely to cause confusion or mistake. Consistent with the avoidance
of confusion or mistake, each tag line use of the Plan’s
Licensed Name: (a) shall be in the style and manner specified
by BCBSA from time-to-time; (b) shall not include the design
service marks; (c) shall not be in a manner to import more
than the Plan’s mere ownership of the Controlled Affiliate;
and (d) shall be restricted to the Service Area. No rights are
hereby created in any Controlled Affiliate to use the Licensed Name
in its own name or otherwise. At least annually, the Plan shall
provide BCBSA with representative samples of each such use of its
Licensed Name pursuant to the foregoing conditions.
4. The Plan
recognizes the importance of a comprehensive national network of
independent BCBSA licensees which are committed to strengthening
the Licensed Marks and Name. The Plan further recognizes that its
actions within its Service Area may affect the value of the
Licensed Marks and Name nationwide. The Plan agrees (a) to
maintain in good standing its membership in BCBSA;
(b) promptly to pay its dues to BCBSA, said dues to represent
the royalties for this License Agreement; (c) materially to
comply with all applicable laws; (d) to comply with the
Membership Standards Applicable to Regular Members of BCBSA, a
current copy of which is attached as Exhibit 2 hereto; and
(e) reasonably to permit BCBSA, upon a written, good faith
request and during reasonable business hours, to inspect the
Plan’s books and records necessary to ascertain compliance
herewith. As to other Plans and third parties, BCBSA shall maintain
the confidentiality of all documents and information furnished by
the Plan pursuant hereto, or pursuant to the Membership Standards,
and clearly designated by the Plan as containing proprietary
information of the Plan.
Amended as of March 17,
2005
-3-
5. The rights
hereby granted are exclusive to the Plan within the geographical
area(s) served by the Plan on June 30, 1972, and/or as to
which the Plan has been granted a subsequent license, which is
hereby defined as the “Service Area,” except that BCBSA
reserves the right to use the Licensed Marks in said Service Area,
and except to the extent that said Service Area may overlap areas
served by one or more other licensed Blue Shield Plans as of said
date or subsequent license, as to which overlapping areas the
rights hereby granted are nonexclusive as to such other Plan or
Plans only.
6. Except as
expressly provided by BCBSA with respect to National Accounts,
Government Programs and certain other necessary and collateral
uses, the current rules and regulations governing which are
attached as Exhibit 3 and Exhibit 4 hereto, and are
contained in other documents referenced herein, or as expressly
provided herein, the Plan may not use the Licensed Marks and Name
outside the Service Area or in connection with other goods and
services, nor may the Plan use the Licensed Marks or Name in a
manner which is intended to transfer in the Service Area the
goodwill associated therewith to another mark or name. Nothing
herein shall be construed to prevent the Plan from engaging in
lawful activity anywhere under other marks and names not
confusingly similar to the Licensed Marks and Name, provided that
engaging in such activity does and will not dilute or tarnish the
unique value of the Licensed Marks and Name. In addition to any and
all remedies available hereunder, BCBSA may impose monetary fines
on the Plan for the Plan’s use of the Licensed Marks and
Names outside the Service Area, and provided that the procedure
used in imposing a fine is consistent with procedures specifically
prescribed by BCBSA from time to time in regulations of general
application. In the case of regional Medicare Advantage PPO and
regional Medicare Part D Prescription Drug Plan products
offered by consenting and participating Plans in a region that
includes the Service Areas, or portions thereof, of more than one
Plan, such fine may be imposed jointly on the consenting and
participating Plans for use of the Licensed Marks and Name in any
geographic area of the region in which a Plan having exclusive
rights to the Licensed Marks and Name does not consent to and
participate in such offering, provided that the basis for
imposition of such fine is consistent with rules specifically
prescribed by BCBSA from time to time in regulations of general
application.
7. The Plan
agrees that it will display the Licensed Marks and Name only in
such form, style and manner as shall be specifically prescribed by
BCBSA from time-to-time in regulations of general application in
order to prevent impairment of the distinctiveness of the Licensed
Marks and Name and the goodwill pertaining thereto. The Plan shall
cause to appear on all materials on or in connection with which the
Licensed Marks or Name are used such legends, markings and notices
as BCBSA may reasonably request in order to give appropriate notice
of service mark or other proprietary rights therein or pertaining
thereto.
Amended as of November 16,
2006
-3a-
8. BCBSA
agrees that: (a) it will not grant any other license effective
during the term of this License Agreement for the use of the
Licensed Marks or Name which is inconsistent with the rights
granted to the Plan hereunder; and (b) it will not itself use
the Licensed Marks in derogation of the rights of the Plan or in a
manner to deprive the Plan of the full benefits of this License
Agreement, provided that BCBSA shall have the right to use the
Licensed Marks in conjunction with any national offering under the
Federal Employees Health Benefits Program in the manner set forth
in Exhibit 4, Paragraph 4 (including subparagraphs) to
this License Agreement. The Plan agrees that it will not attack the
title of BCBSA in and to the Licensed Marks or Name or attack the
validity of the Licensed Marks or of this License Agreement. The
Plan further agrees that all use by it of the Licensed Marks and
Name or any similar mark or name shall inure to the benefit of
BCBSA, and the Plan shall cooperate with BCBSA in effectuating the
assignment to BCBSA of any service mark or trademark registrations
of the Licensed Marks or any similar mark or name held by the Plan
or a Controlled Affiliate of the Plan, all or any portion of which
registration consists of the Licensed Marks.
9. (a).
Should the Plan fail to comply with the provisions of paragraphs
2-4, 6, 7 and/or 12, and not cure such failure within thirty
(30) days of receiving written notice thereof (or commence
curing such failure within such thirty day period and continue
diligent efforts to complete the curing of such failure if such
curing cannot reasonably be completed within such thirty day
period), BCBSA shall have the right to issue a notice that the Plan
is in a state of noncompliance. Except as to the termination of a
Plan’s License Agreement or the merger of two or more Plans,
disputes as to noncompliance, and all other disputes between or
among BCBSA, the Plan, other Plans and/or Controlled Affiliates,
shall be submitted promptly to mediation and mandatory dispute
resolution pursuant to the rules and regulations of BCBSA, a
current copy of which is attached as Exhibit 5 hereto, and
shall be timely presented and resolved. The mandatory dispute
resolution panel shall have authority to issue orders for specific
performance and assess monetary penalties. If a state of
noncompliance as aforesaid is undisputed by the Plan 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 License Agreement. Except, however, as provided
in paragraphs 9(d)(iii), 15(a)(i)-(viii), and 15(a)(x) below, no
Plan’s license to use the Licensed Marks and Name may be
finally terminated for any reason without the affirmative vote of
three-fourths of the Plans and three-fourths of the total then
current weighted vote of all the Plans.
Amended as of March 16,
2006
-4-
(b).
Notwithstanding any other provision of this License Agreement, a
Plan’s license to use the Licensed Marks and Name may be
forthwith terminated by the affirmative vote of three-fourths of
the Plans and three-fourths of the total then current weighted vote
of all the Plans 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 Member Plans
for: (i) failure to comply with any minimum capital or
liquidity requirement under the Membership Standard on Financial
Responsibility; or (ii) impending financial insolvency; or
(iii) the pendency of any action instituted against the Plan
seeking its dissolution or liquidation or 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 of
business, unless this License Agreement has been earlier terminated
under paragraph 15(a); or (iv) such other reason as is
determined in good faith immediately and irreparably to threaten
the integrity and reputation of BCBSA, the Plans and/or the
Licensed Marks.
(c).
To the extent not otherwise provided therein, neither: (i) the
Membership Standards Applicable to Regular Members of BCBSA; nor
(ii) the rules and regulations governing Government Programs
and certain other uses; nor (iii) the rules and regulations
governing mediation and mandatory dispute resolution, may be
amended unless and until each such amendment is first adopted by
the affirmative vote of three-fourths of the Plans and of
three-fourths of the total then current weighted vote of all the
Plans. The rules and regulations governing National Accounts and
other national programs required by the Membership Standards
Applicable to Regular Members of BCBSA (Exhibit 2) are
contained, in addition to those set forth in Exhibit 3, in the
following documents, as amended from time to time: (1) the
Transfer Program Policies and Provisions; (2) the Inter-Plan
Programs Policies and Provisions; (3) Inter-Plan Medicare
Advantage Program Policies and Provisions. The voting requirements
specified in rules and regulations governing such national programs
may not be amended unless and until each such amendment is first
adopted by the affirmative vote of three-fourths of the Plans and
of three-fourths of the total then current weighted vote of all the
Plans.
Amended November 15,
2007
-4a-
9.
(d). The Plan may operate as a for-profit company on the following
conditions:
(i) The Plan
shall discharge all responsibilities which it has to the
Association and to other Plans by virtue of this Agreement and the
Plan’s membership in BCBSA.
(ii) The Plan
shall not use the licensed Marks and Name, or any derivative
thereof, as part of its legal name or any symbol used to identify
the Plan in any securities market. The Plan shall use the licensed
Marks and Name as part of its trade name within its service area
for the sale, marketing and administration of health care and
related services in the service area.
(iii) The
Plan’s license to use the Licensed Marks and Name shall
automatically terminate effective: (a) thirty days after the
Plan knows, or there is an SEC filing indicating that, any
Institutional Investor, has become the Beneficial Owner of
securities representing 10% or more of the voting power of the Plan
(“Excess Institutional Voter”), unless such Excess
Institutional Voter shall cease to be an Excess Institutional Voter
prior to such automatic termination becoming effective;
(b) thirty days after the Plan knows, or there is an SEC
filing indicating that, any Noninstitutional Investor has become
the Beneficial Owner of securities representing 5% or more of the
voting power of the Plan (“Excess Noninstitutional
Voter”) unless such Excess Noninstitutional Voter shall cease
to be an Excess Noninstitutional Voter prior to such automatic
termination becoming effective; (c) thirty days after the Plan
knows, or there is an SEC filing indicating that, any Person has
become the Beneficial Owner of 20% or more of the Plan’s then
outstanding common stock or other equity securities which (either
by themselves or in combination) represent an ownership interest of
20% or more pursuant to determinations made under paragraph
9(d)(iv) below (“Excess Owner”), unless such Excess
Owner shall cease to be an Excess Owner prior to such automatic
termination becoming effective; (d) ten business days after
individuals who at the time the Plan went public constituted the
Board of Directors of the Plan (together with any new directors
whose election to the Board was approved by a vote of 2/3 of the
directors then still in office who were directors at the time the
Plan went public or whose election or nomination was previously so
approved) (the “Continuing Directors”) cease for any
reason to constitute a majority of the Board of Directors; or
(e) ten business days after the Plan consolidates with or
merges with or into any person or conveys, assigns, transfers or
sells all or substantially all of its assets to any person other
than a merger in which the Plan is the surviving entity and
immediately after which merger, no person is an Excess
Institutional Voter, an Excess Noninstitutional Voter or an Excess
Owner: provided that, if requested by the affected Plan in a
writing received by BCBSA prior to such automatic termination
becoming effective, the provisions of this paragraph 9(d)(iii) may
be waived, in whole or in part,
Amended as of September 17,
1997
-5-
upon the
affirmative vote of a majority of the disinterested Plans and a
majority of the total then current weighted vote of the
disinterested Plans. Any waiver so granted may be conditioned upon
such additional requirements (including but not limited to imposing
new and independent grounds for termination of this License) as
shall be approved by the affirmative vote of a majority of the
disinterested Plans and a majority of the total then current
weighted vote of the disinterested Plans. If a timely waiver
request is received, no automatic termination shall become
effective until the later of: (1) the conclusion of the
applicable time period specified in paragraphs 9(d)(iii)(a)-(d)
above, or (2) the conclusion of the first Member Plan meeting
after receipt of such a waiver request.
In the event
that the Plan’s license to use the Licensed Marks and Name is
terminated pursuant to this Paragraph 9(d)(iii), the license
may be reinstated in BCBSA’s sole discretion if, within 30
days of the date of such termination, the Plan demonstrates that
the Person referred to in clause (a), (b) or (c) of the
preceding paragraph is no longer an Excess Institutional Voter, an
Excess Noninstitutional Voter or an Excess Owner.
(iv) The Plan
shall not issue any class or series of security other than
(i) shares of common stock having identical terms or options
or derivatives of such common stock, (ii) non-voting,
non-convertible debt securities or (iii) such other securities
as the Plan may approve, provided that BCBSA receives notice at
least thirty days prior to the issuance of such securities,
including a description of the terms for such securities, and BCBSA
shall have the authority to determine how such other securities
will be counted in determining whether any Person is an Excess
Institutional Voter, Excess Noninstitutional Voter or an Excess
Owner.
(v) For
purposes of paragraph 9(d)(iii), the following definitions shall
apply:
(a)
“Affiliate” and “Associate” shall have the
respective meanings ascribed to such terms in Rule 12b-2 of
the General Rules and Regulations under the Securities Exchange Act
of 1934, as amended and in effect on November 17, 1993 (the
“Exchange Act”).
(b) A Person shall
be deemed the “Beneficial Owner” of and shall be deemed
to “beneficially own” any securities:
(i)
which such Person or any of such Person’s Affiliates or
Associates beneficially owns, directly or indirectly;
Amended as of September 17,
1997
-5a-
(ii)
which such Person or any of such Person’s Affiliates or
Associates has (A) the right to acquire (whether such right is
exercisable immediately or only after the passage of time) pursuant
to any agreement, arrangement or understanding, or upon the
exercise of conversion rights, exchange rights, warrants or
options, or otherwise; or (B) the right to vote pursuant to
any agreement, arrangement or understanding; provided, however,
that a Person shall not be deemed the Beneficial Owner of, or to
beneficially own, any security if the agreement, arrangement or
understanding to vote such security (1) arises solely from a
revocable proxy or consent given to such Person in response to a
public proxy or consent solicitation made pursuant to, and in
accordance with, the applicable rules and regulations promulgated
under the Exchange Act and (2) is not also then reportable on
Schedule 13D under the Exchange Act (or any comparable or
successor report); or
(iii)
which are beneficially owned, directly or indirectly, by any other
Person (or any Affiliate or Associate thereof) with which such
Person (or any of such Person’s Affiliates or Associates) has
any agreement, arrangement or understanding (other than customary
agreements with and between underwriters and selling group members
with respect to a bona fide public offering of securities) relating
to the acquisition, holding, voting (except to the extent
contemplated by the proviso to (b)(ii)(B) above) or disposing of
any securities of the Plan.
Notwithstanding
anything in this definition of Beneficial Ownership to the
contrary, the phrase “then outstanding,” when used with
reference to a Person’s Beneficial Ownership of securities of
the Plan, shall mean the number of such securities then issued and
outstanding together with the number of such securities not then
actually issued and outstanding which such Person would be deemed
to own beneficially hereunder.
(c) A Person shall
be deemed an “Institutional Investor” if (but only if)
such Person (i) is an entity or group identified in the
SEC’s Rule 13d-1(b)(1)(ii) as constituted on
June 1, 1997, and (ii) every filing made by such Person
with the SEC under Regulation 13D-G (or any successor
Regulation) with respect to such Person’s Beneficial
Ownership of Plan securities shall have contained a certification
identical to the one required by item 10 of SEC Schedule 13G
as constituted on June 1, 1997.
(d)
“Noninstitutional Investor” means any Person who is not
an Institutional Investor.
(e)
“Person” shall mean any individual, firm, partnership,
corporation, trust, association, joint venture or other entity, and
shall include any successor (by merger or otherwise) of such
entity.
Amended as of September 17,
1997
(The next page is page
6)
-5b-
10. This
License Agreement shall remain in effect: (a) until terminated
as provided herein; or (b) until this and all such other
License Agreements are terminated by the affirmative vote of
three-fourths of the Plans and three-fourths of the total then
current weighted vote of all the Plans; (c) until terminated
by the Plan upon eighteen (18) months written notice to BCBSA
or upon a shorter notice period approved by BCBSA in writing at its
sole discretion.
11. Except as
otherwise provided in paragraph 15 below or by the affirmative vote
of three-fourths of the Plans and three-fourths of the total then
current weighted vote of all the Plans, or unless this and all such
other License Agreements are simultaneously terminated by force of
law, the termination of this License Agreement for any reason
whatsoever shall cause the reversion to BCBSA of all rights in and
to the Licensed Marks and Name, and the Plan agrees that it will
promptly discontinue all use of the Licensed Marks and Name, will
not use them thereafter, and will promptly, upon written notice
from BCBSA, change its corporate name so as to eliminate the
Licensed Name therefrom.
12. The
license hereby granted to Plan to use the Licensed Marks and Name
is and shall be personal to the Plan so licensed and shall not be
assignable by any act of the Plan, directly or indirectly, without
the written consent of BCBSA. Said license shall not be assignable
by operation of law, nor shall Plan mortgage or part with
possession or control of this license or any right hereunder, and
the Plan shall have no right to grant any sublicense to use the
Licensed Marks and Name.
13. BCBSA
shall maintain appropriate service mark registrations of the
Licensed Marks and BCBSA shall take such lawful steps and
proceedings as may be necessary or proper to prevent use of the
Licensed Marks by any person who is not authorized to use the same.
Any actions or proceedings undertaken by BCBSA under the provisions
of this paragraph shall be at BCBSA’s sole cost and expense.
BCBSA shall have the sole right to determine whether or not any
legal action shall be taken on account of unauthorized use of the
Licensed Marks, such right not to be unreasonably exercised. The
Plan shall report any unlawful usage of the Licensed Marks to BCBSA
in writing and agrees, free of charge, to cooperate fully with
BCBSA’s program of enforcing and protecting the service mark
rights, trade name rights and other rights in the Licensed
Marks.
14. The Plan
hereby agrees to save, defend, indemnify and hold BCBSA and any
other Plan(s) harmless from and against all claims, damages,
liabilities and costs of every kind, nature and description which
may arise exclusively and directly as a result of the activities of
the Plan. BCBSA hereby agrees to save, defend, indemnify and hold
the Plan and any other Plan(s) harmless from and against all
claims, damages, liabilities and costs of every kind, nature and
description which may arise exclusively and directly as a result of
the activities of BCBSA.
Amended as of June 16,
2005
-6-
15. (a). This
Agreement shall automatically terminate upon the occurrence of any
of the following events: (i) a voluntary petition shall be
filed by the Plan or by BCBSA 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 the Plan or BCBSA 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 the Plan or BCBSA 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 Plan or BCBSA respectively, or (iii) an order for relief
is entered against the Plan or BCBSA in any case under the
bankruptcy laws of the United States, or the Plan or BCBSA is
adjudged bankrupt or insolvent (as that term is defined in the
Uniform Commercial Code as enacted in the state of Illinois) by any
court of competent jurisdiction, or (iv) the Plan or BCBSA
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 the Plan or
delinquency proceedings (voluntary or involuntary) are instituted,
or (vi) an action is brought by the Plan or BCBSA 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 the Plan or BCBSA
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 and such action is
consented to or acquiesced in by the Plan or BCBSA 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 Plan or BCBSA respectively, 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 the Plan’s or
BCBSA’s property or business is appointed, or the Plan or
BCBSA is ordered dissolved or liquidated, or (ix) the Plan
shall fail to pay its dues and shall not cure such failure within
thirty (30) days of receiving written notice thereof, or
(x) if, due to regulatory action, the Plan together with any
applicable Controlled Affiliate becomes unable to do business using
the Names and Marks in any State or portion thereof included in its
Service Area, provided that: (i) automatic termination shall
not occur prior to the exhaustion by any such Plan of its rights to
appeal or challenge such regulatory action; and (ii) in the
event the Plan is licensed to do business using the Names and Marks
in multiple States or portions of States, the termination of its
License Agreement shall be solely limited to the State(s) or
portions thereof in which the regulatory action applies. 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.
-7-
Notwithstanding
any other provision of this Agreement, a declaration or a request
for declaration of the existence of a trust over any of the
Plan’s or BCBSA’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 15(a)(vii) and (viii) of this
Agreement.
Amended as of September 14,
2004
-7a-
(b). BCBSA, or the
Plans (as provided and in addition to the rights conferred in
Paragraph 10(b) above), may terminate this Agreement immediately
upon written notice upon the occurrence of either of the
following events: (a) the Plan or BCBSA becomes insolvent (as
that term is defined in the Uniform Commercial Code enacted in the
state of Illinois), or (b) any final judgment against the Plan
or BCBSA remains unsatisfied or unbonded of record for a period of
sixty (60) days or longer.
(c). If this
License Agreement is terminated as to BCBSA for any reason stated
in subparagraphs 15(a) and (b) above, the ownership of the
Licensed Marks shall revert to each of the Plans.
(d). Upon
termination of this License Agreement or any Controlled Affiliate
License Agreement of a Larger Controlled Affiliate, as defined in
Exhibit 1 to this License Agreement, the following conditions
shall apply, except that, in the event of a partial termination of
this Agreement pursuant to Paragraph 15 (a)(x)(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:
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(i)
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The
terminated entity 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 terminated entity or
its Controlled Affiliates 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 or, if
termination is pursuant to paragraph 10(c) of this Agreement,
within 15 days after the written notice to BCBSA described in
paragraph 10(c).
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(ii)
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The
terminated entity shall deliver to BCBSA within five days of a
request by BCBSA a listing of national accounts in which the
terminated entity is involved (in a Control, Participating or
Servicing capacity), identifying the national account and the
terminated entity’s role therein. For those accounts where
the terminated entity is the Control Plan, the Plan must also
indicate the Participating and Servicing Plans in the national
account syndicate.
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Amended as of June 16,
2005
-8-
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(iii)
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Unless the cause of termination is
an event stated in paragraph 15(a) or (b) above respecting
BCBSA, the Plan and its Licensed Controlled Affiliates 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 terminated entity and its Licensed
Controlled Affiliates; 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 terminated entity and its Licensed
Controlled Affiliates and the denominator of which is the total
number of Licensed Enrollees in the Service Area. 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 the 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 (a) the end of the last fiscal
year of the terminated entity which ended prior to termination or
(b) the fiscal year which ended before any transactions causing the
termination began. Notwithstanding the foregoing, the amount
payable pursuant to this subparagraph (d)(iii) shall be due
only
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Amended as of June 16,
2005
-8a-
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to
the extent that, in BCBSA’s opinion, it does not cause the
net worth 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 Plan 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 terminated entity’s license is reinstated by
BCBSA or is deemed to have remained in effect without interruption
by a court of competent jurisdicition, BCBSA shall reimburse the
Plan (and/or its Licensed Controlled Affiliates, as the case may
be) for payments made under this subparagraph only to the extent
that such payments exceed the amounts due to BCBSA pursuant to
subparagraph 15(d)(vi) and any costs associated with reestablishing
the Service Area, including any payments made by BCBSA to a Plan or
Plans (or their Licensed Controlled Affiliates) for purposes of
replacing the terminated entity.
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(iv)
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The
terminated entity shall comply with all financial settlement
procedures set forth in BCBSA’s License Termination
Contingency Plan, as amended from time
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Amended as of June 16,
2005
-8b-
to time and
shall work diligently and in good faith with BCBSA, any Alternative
Control Licensee or Replacement Licensee and any existing or
potential new account for Blue-branded products and services to
minimize the disruption of termination, and honor, to the fullest
extent possible, the desire of accounts to continue to receive or
obtain Blue-branded products and services through a new Licensee
(“Transition”). Such diligence and good faith on the
part of the terminated entity shall include, but not be limited to:
(a) working cooperatively with BCBSA to protect the Names and
Marks from potential harm; (b) cooperating with BCBSA’s
use of the Names and Marks in the terminated entity’s former
service area during the termination and Transition;
(c) transmitting, upon the request of an existing Blue account
or of BCBSA with consent and on behalf of an existing Blue account,
all member and account-data relating to the Federal Employee
Program to BCBSA, and all member and account data relating to other
programs to an Alternative Control Licensee or Replacement
Licensee; (d) working with BCBSA and the Alternative Control
or Replacement Licensee with respect to potential new Blue accounts
headquartered in the terminated entity’s former service area;
(e) continuing to service Blue accounts during the Transition;
(f) continuing to comply with National Programs, Federal
Employee Program and NASCO policies and procedures and all
voluntary BCBSA programs, policies and performance standards, such
as Away From Home Care, including being responsible for payment of
all penalties for non-compliance duly levied in conformity with the
License Agreements, Membership Standards, or the Federal Employee
Program agreements, that may arise during the Transition; (g)
maintaining and providing access to its provider networks, as
defined by Federal Employee Program agreements and National Account
Program Policies and Provisions, and Inter-Plan Programs Policies
and Provisions, and making those networks and discounts available
to members and providers who participate in National Programs and
the Federal Employee Program during the Transition;
(h) maintaining its technical connections and processing
capabilities during the Transition; and (i) working diligently
to conclude all financial settlements and account reconciliations
as negotiated in the termination transition agreement.
Amended as of November 16,
2006
-8c-
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(v)
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Notwithstanding any other provision
in this Agreement, BCBSA shall have the right, with the approval of
its Board of Directors, to assess additional fines against the
terminated entity during the Transition in the event it fails to
maintain and provide access to provider networks as defined by
Federal Employee Program agreements, National Account Program
Policies and Provisons, and Inter-Plans Programs Policies and
Provisions, and/or pass on applicable discounts. Such fines shall
be in addition to any other assessments, fees or liquidated damages
payable herein, or under existing policies and programs and shall
be imposed to make whole BCBSA and/or the Plans. Terminated entity
shall pay any such fines to BCBSA no later than 30 days after
they are approved by the Board of Directors.
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(vi)
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BCBSA shall have the right to
examine and audit and/or hire at terminated entity’s expense
a third-party auditor to examine and audit the books and records of
the terminated entity and its Licensed Controlled Affiliates to
verify compliance with the terms and requirements of this paragraph
15(d).
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(vii)
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Subsequent to termination of this
Agreement, the terminated entity and its affiliates, agents, and
employees shall have an ongoing and continuing obligation to
protect all BCBSA and Blue Licensee data that was acquired or
accessed during the period this Agreement was in force, including
but not limited to all confidential processes, pricing, provider,
discount and other strategic and competitively sensitive
information (“Blue Information”) from disclosure, and
shall not, either alone or with another entity, disclose such Blue
Information or use it in any manner to compete without the express
written permission of BCBSA.
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(viii)
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As
to a breach of 15 (d) (i), (ii), (iii), (iv), (vi), or
(vii) the parties agree that the obligations are immediately
enforceable in a court of competent jurisdiction. As to a breach of
15 (d) (i), (ii), (iv), (vi), or (vii) by the Plan, the
parties agree there is no adequate remedy at law and BCBSA is
entitled to obtain specific performance.
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Amended as of November 16,
2006
-8d-
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(ix)
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In
the event that the terminated entity’s license is reinstated
by BCBSA or is deemed to have remained in effect without
interruption by a court of competent jurisdiction, the Plan and its
Licensed Controlled Affiliates shall be jointly liable for
reimbursing BCBSA the reasonable costs incurred by BCBSA in
connection with the termination and the reinstatement or court
action, and any associated legal proceedings, including but not
limited to: outside legal fees, consulting fees, public relations
fees, advertising costs, and costs incurred to develop, lease or
establish an interim provider network. Any amount due to BCBSA
under this subparagraph may be waived in whole or in part by the
BCBSA Board of Directors in its sole discretion.
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(e). BCBSA shall
be entitled to enjoin the Plan or any related party in a court of
competent jurisdiction from entry into any transaction which would
result in a termination of this License Agreement unless the
License Agreement has been terminated pursuant to paragraph 10
(d) of this Agreement upon the required six (6) month
written notice.
(f). BCBSA
acknowledges that it is not the owner of assets of the
Plan.
Amended as of June 16,
2005
-8e-
16. This
Agreement supersedes any and all other agreements between the
parties with respect to the subject matter herein, and contains all
of the covenants and agreements of the parties as to the licensing
of the Licensed Marks and Name. This Agreement may be amended only
by the affirmative vote of three-fourths of the Plans and
three-fourths of the total then current weighted vote of all the
Plans as officially recorded by the BCBSA Corporate
Secretary.
17. If any
provision or any part of any provision of this Agreement is
judicially declared unlawful, each and every other provision, or
any part of any provision, shall continue in full force and effect
notwithstanding such judicial declaration.
18. No waiver
by BCBSA or the Plan of any breach or default in performance on the
part of BCBSA or the Plan or any other licensee of any of the
terms, covenants or conditions of this Agreement shall constitute a
waiver of any subsequent breach or default in performance of said
terms, covenants or conditions.
19a. All notices
provided for hereunder shall be in writing and shall be sent in
duplicate by regular mail to BCBSA or the Plan at the address
currently published for each by BCBSA and shall be marked
respectively to the attention of the President and, if any, the
General Counsel, of BCBSA or the Plan.
Amended as of November 20,
1997
-8f-
19b. Except as
provided in paragraphs 9(b), 9(d)(iii), 15(a), and 15(b) above,
this Agreement may be terminated for a breach only upon at least
30 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 Member
Plans.
19c. For all
provisions of this Agreement referring to voting, the term
‘Plans’ shall mean all entities licensed under the Blue
Cross License Agreement and/or the Blue Shield License Agreement,
and in all votes of the Plans under this Agreement the Plans shall
vote together. For weighted votes of the Plans, the Plan shall have
a number of votes equal to the number of weighted votes (if any)
that it holds as a Blue Cross Plan plus the number of weighted
votes (if any) that it holds as a Blue Shield Plan. For all other
votes of the Plans, the Plan shall have one vote. For all questions
requiring an affirmative three-fourths weighted vote of the Plans,
the requirement shall be deemed satisfied with a lesser weighted
vote unless the greater of: (i) 6/52 or more of the Plans
(rounded to the nearest whole number, with 0.5 or multiples thereof
being rounded to the next higher whole number) fail to cast
weighted votes in favor of the question; or (ii) three
(3) of the Plans fail to cast weighted votes in favor of the
question. Notwithstanding the foregoing provision, if there are
thirty-nine (39) Plans, the requirement of an affirmative
three-fourths weighted vote shall be deemed satisfied with a lesser
weighted vote unless four (4) or more Plans fail to cast weighted
votes in favor of the question.
Amended as of June 16,
2005
(The next page is page
9)
-8g-
20. Nothing
herein contained shall be construed to constitute the parties
hereto as partners or joint venturers, or either as the agent of
the other, and Plan shall have no right to bind or obligate BCBSA
in any way, nor shall it represent that it has any right to do so.
BCBSA shall have no liability to third parties with respect to any
aspect of the business, activities, operations, products, or
services of the Plan.
21. This
Agreement shall be governed, construed and interpreted in
accordance with the laws of the State of Illinois.
IN WITNESS
WHEREOF, the parties have caused this License Agreement to be
executed, effective as of the date of last signature written
below.
BLUE CROSS
AND BLUE SHIELD ASSOCIATION
-9-
BLUE SHIELD
CONTROLLED AFFILIATE LICENSE AGREEMENT
(Includes revisions adopted by Member Plans through their
November 13, 2008 meeting)
This Agreement by
and among Blue Cross and Blue Shield Association
(“BCBSA”) and
(“Controlled Affiliate”), a Controlled Affiliate of the
Blue Shield Plan(s), known as
(“Plan”), which is also a Party signatory
hereto.
WHEREAS, BCBSA is
the owner of the BLUE SHIELD and BLUE SHIELD Design service
marks;
WHEREAS, Plan and
Controlled Affiliate desire that the latter be entitled to use the
BLUE SHIELD and BLUE SHIELD Design service marks (collectively the
“Licensed Marks”) as service marks and be entitled to
use the term BLUE SHIELD 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.
3
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.
E. 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.
4
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
5
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.
6
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
7
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
8
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 to have remained in effect without interruption by a
court of competent jurisdiction, BCBSA shall reimburse the
Controlled Affiliate (and/or the Plan or its other Licensed
Controlled Affiliates, as the case may be) for payments made under
this subparagraph 7.H.(3) only to the extent that such payments
exceed the amounts due to BCBSA pursuant to paragraph 7.M. and any
cost associated with reestablishing the Service Area, including any
payments made by BCBSA to a Plan or Plans (or their Licensed
Controlled Affiliates) for purposes of replacing the Controlled
Affiliate.
9
(4) BCBSA
shall have the right to examine and audit and/or hire at terminated
entity’s expense a third party auditor to examine and audit
the books and records of the Controlled Affiliate, the Plan, and
any other Licensed Controlled Affiliates of the Plan to verify
compliance with this paragraph 7.H.
(5) Subsequent
to termination of this Agreement, the terminated entity and its
affiliates, agents, and employees shall have an ongoing and
continuing obligation to protect all BCBSA and Blue Licensee data
that was acquired or accessed during the period this Agreement was
in force, including but not limited to all confidential processes,
pricing, provider, discount and other strategic and competitively
sensitive information (“Blue Information”) from
disclosure, and shall not, either alone or with another entity,
disclose such Blue Information or use it in any manner to compete
without the express written permission of BCBSA.
(6) As to a
breach of 7.H.(1), (2), (3), (4) or (5) the parties agree
that the obligations are immediately enforceable in a court of
competent jurisdiction. As to a breach of 7.H.(1), (2) or
(4) by the Controlled Affiliate, the parties agree there is no
adequate remedy at law and BCBSA is entitled to obtain specific
performance.
I. This
Agreement shall remain in effect until terminated by the Controlled
Affiliate upon not less than eighteen (18) months written
notice to the Association or upon a shorter notice period approved
by BCBSA in writing at its sole discretion, or until terminated as
otherwise provided herein.
J. In the
event the Controlled Affiliate is a Smaller Controlled Affiliate
(as defined in Exhibit A), the Controlled Affiliate agrees to
be jointly liable for the amount described in H.3.and M. hereof
upon termination of the BCBSA license agreement of any Larger
Controlled Affiliate of the Plan.
K. BCBSA
shall be entitled to enjoin the Controlled Affiliate or any related
party in a court of competent jurisdiction from entry into any
transaction which would result in a termination of this Agreement
unless the Plan’s license from BCBSA to use the Licensed
Marks and Names has been terminated pursuant to 10(d) of the
Plan’s license agreement upon the required 6 month
written notice.
L. BCBSA
acknowledges that it is not the owner of assets of the Controlled
Affiliate.
M. In the
event that the Plan has more than 50 percent voting control of
the Controlled Affiliate under Paragraph 2(E)(2) above and is
a Larger Controlled Affiliate (as defined in Exhibit A), then the
vote called for in Paragraphs 7(C) and 7(D) above shall require the
affirmative vote of three-fourths of the Plans and three-fourths of
the total then current weighted vote of all the Plans.
Amended as of June 16,
2005
10
N. In the
event this Agreement terminates and is subsequently reinstated by
BCBSA or is deemed to have remained in effect without interruption
by a court of competent jurisdicition, the Controlled Affiliate,
the Plan, and any other Licensed Controlled Affiliates of the Plan
shall be jointly liable for reimbursing BCBSA the reasonable costs
incurred by BCBSA in connection with the termination and the
reinstatement or court action, and any associated legal
proceedings, including but not limited to: outside legal fees,
consulting fees, public relations fees, advertising costs, and
costs incurred to develop, lease or establish an interim provider
network. Any amount due to BCBSA under this subparagraph may be
waived in whole or in part by the BCBSA Board of Directors in its
sole discretion.
The parties agree
that any disputes between them or between or among either of them
and one or more Plans or Controlled Affiliates of Plans that use in
any manner the Blue Shield and Blue Shield Marks and Name are
subject to the Mediation and Mandatory Dispute Resolution process
attached to and made a part of Plan’s License from BCBSA to
use the Licensed Marks and Name as Exhibit 5 as amended from
time-to-time, which documents are incorporated herein by reference
as though fully set forth herein.
Controlled
Affiliate will pay to BCBSA a fee for this License determined
pursuant to the formula(s) set forth in Exhibit B.
Nothing contained
in the Agreement shall be construed as creating a joint venture,
partnership, agency or employment relationship between Plan and
Controlled Affiliate or between either and BCBSA.
Amended September 20,
2007
11
11.
NOTICES AND CORRESPONDENCE
Notices regarding
the subject matter of this Agreement or breach or termination
thereof shall be in writing and shall be addressed in duplicate to
the last known address of each other party, marked respectively to
the attention of its President and, if any, its General
Counsel.
This Agreement
contains the complete understandings of the parties in relation to
the subject matter hereof. This Agreement may only be amended by
the affirmative vote of three-fourths of the Plans and
three-fourths of the total then current weighted vote of all the
Plans as officially recorded by the BCBSA Corporate
Secretary.
If any term of
this Agreement is held to be unlawful by a court of competent
jurisdiction, such findings shall in no way affect the remaining
obligations of the parties hereunder and the court may substitute a
lawful term or condition for any unlawful term or condition so long
as the effect of such substitution is to provide the parties with
the benefits of this Agreement.
No waiver by BCBSA
of any breach or default in performance on the part of Controlled
Affiliate or any other licensee of any of the terms, covenants or
conditions of this Agreement shall constitute a waiver of any
subsequent breach or default in performance of said terms,
covenants or conditions.
For all
provisions of this Agreement referring to voting, the term
‘Plans’ shall mean all entities licensed under the Blue
Cross License Agreement and/or the Blue Shield License Agreement,
and in all votes of the Plans under this Agreement the Plans shall
vote together. For weighted votes of the Plans, the Plan shall have
a number of votes equal to the number of weighted votes (if any)
that it holds as a Blue Cross Plan plus the number of weighted
votes (if any) that it holds as a Blue Shield Plan. For all other
votes of the Plans, the Plan shall have one vote. For all questions
requiring an affirmative three-fourths weighted vote of the Plans,
the requirement shall be deemed satisfied with a lesser weighted
vote unless the greater of: (i) 6/52 or more of the Plans
(rounded to the nearest whole number, with 0.5 or multiples thereof
being rounded to the next higher whole number) fail to cast
weighted votes in favor of the question; or (ii) three (3) of
the Plans fail to cast weighted votes in favor of the question.
Notwithstanding the foregoing provision, if there are thirty-nine
(39) Plans, the requirement of an affirmative three-fourths
weighted vote shall be deemed satisfied with a lesser weighted vote
unless four (4) or more Plans fail to cast weighted votes in
favor of the question.
Amended as of June 16,
2005
12
THIS PAGE IS INTENTIONALLY
BLANK.
13
This Agreement
shall be governed by, and construed and interpreted in accordance
with, the laws of the State of Illinois.
The headings
inserted in this agreement are for convenience only and shall have
no bearing on the interpretation hereof.
IN WITNESS
WHEREOF, the parties have caused this License Agreement to be
executed and effective as of the date of last signature written
below.
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Controlled
Affiliate:
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Plan:
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BLUE CROSS
AND BLUE SHIELD ASSOCIATION
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14
CONTROLLED
AFFILIATE LICENSE STANDARDS
November 2008
PREAMBLE
The standards
for licensing Controlled Affiliates are established by BCBSA and
are subject to change from time-to-time upon the affirmative vote
of three-fourths (3/4) of the Plans and three-fourths (3/4) of the
total weighted vote. Each licensed Plan is required to use a
standard Controlled Affiliate license form provided by BCBSA and to
cooperate fully in assuring that the licensed Controlled Affiliate
maintains compliance with the license standards.
The Controlled
Affiliate License provides a flexible vehicle to accommodate the
potential range of health and workers’ compensation related
products and services Plan Controlled Affiliates provide. The
Controlled Affiliate License collapses former health Controlled
Affiliate licenses (HCC, HMO, PPO, TPA, and IDS) into a single
license using the following business-based criteria to provide a
framework for license standards:
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Percent of Controlled Affiliate
controlled by parent: Greater than 50 percent or
50 percent?
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Risk assumption: yes or
no?
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Medical care delivery: yes or
no?
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Size of the Controlled Affiliate: If
the Controlled Affiliate has health or workers’ compensation
administration business, does such business constitute
15 percent or more of the parent’s and other licensed
health subsidiaries’ member enrollment?
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Amended September 19,
2002
15
For purposes of
definition:
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A
“smaller Controlled Affiliate:” (1) comprises less
than fifteen percent (15%) of Plan’s and its licensed
Controlled Affiliates’ total member enrollment (as reported
on the BCBSA Quarterly Enrollment Report, excluding rider and
freestanding coverage, and treating an entity seeking licensure as
licensed);* or (2) underwrites the indemnity portion of
workers’ compensation insurance and has total premium revenue
less than 15 percent of the sponsoring Plan’s net
subscription revenue.
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A
“larger Controlled Affiliate” comprises fifteen percent
(15%) or more of Plan’s and its licensed Controlled
Affiliates’ total member enrollment (as reported on the BCBSA
Quarterly Enrollment Report, excluding rider and freestanding
coverage, and treating an entity seeking licensure as
licensed.)*
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Changes in
Controlled Affiliate status:
If any
Controlled Affiliate’s status changes regarding: its Plan
ownership level, its risk acceptance or direct delivery of medical
care, the Controlled Affiliate shall notify BCBSA within thirty
(30) days of such occurrence in writing and come into
compliance with the applicable standards within six
(6) months.
If a smaller
Controlled Affiliate’s health and workers’ compensation
administration business reaches or surpasses fifteen percent (15%)
of the total member enrollment of the Plan and licensed Controlled
Affiliates, the Controlled Affiliate shall:
Amended September 19,
2002
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1.
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Within thirty (30) days, notify
BCBSA of this fact in writing, including evidence that the
Controlled Affiliate meets the minimum liquidity and capital (BCBSA
“Health Risk-Based Capital (HRBC)” as defined by the
NAIC and state-established minimum reserve) requirements of the
larger Controlled Affiliate Financial Responsibility standard;
and
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2.
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Within six (6) months after
reaching or surpassing the fifteen percent (15%) threshold,
demonstrate compliance with all license requirements for a larger
Controlled Affiliate.
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If a Controlled
Affiliate that underwrites the indemnity portion of workers’
compensation insurance receives a change in rating or proposed
change in rating, the Controlled Affiliate shall notify BCBSA
within 30 days of notification by the external rating
agency.
*For purposes
of this calculation,
Applicant
Controlled Affiliate’s member enrollment, as defined in
BCBSA’s Quarterly Enrollment Report (excluding rider and
freestanding coverage).
Numerator PLUS
Plan and all other licensed Controlled Affiliates’ member
enrollment, as reported in BCBSA’s Quarterly Enrollment
Report (excluding rider and freestanding coverage).
Amended September 19,
2002
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