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<br />I. OUR DUTIES <br /> <br />a. We agree to process all claims presented on behalf of eligible persons for the payment of <br />benefits according to the terms of the Plan. Payment of claims shall be advanced by our <br />check subject to immediate reimbursement by you in accordance with paragraph ILa. of this <br />Agreement. We advance funds only for pur:poses of administrative and accounting <br />convenience. We do not insure the Plan. We will not pay any benefits which are not <br />payable under the Plan. We will not process any claim which was incurred prior to the <br />Effective Date shown in the Schedule, unless authorized by you in writing prior to <br />payment. <br />b. We agree to provide, at monthly intervals, a listing of all Plan benefits paid. One custom <br />report is provided, at your request, at no cost per plan year. Subsequent custom reports will <br />be billed as shown in the schedule. <br />c. We agree to design, review and print (i) standard forms to explain benefits to employees, <br />(ii) claim forms, and (iii) standard administrative forms such as enrollment cards, evidence <br />of good health forms and other necessary reporting forms. <br />d. We agree to provide actuarial services including (i) annual cost projections, (ii) cost <br />projections for Plan modifications; and (iii) estimates of reserve amounts required to fund <br />the Plan on a current basis. <br />e. We agree to provide assistance to you in designing your Plan benefits based on coverage <br />adequacy, cost control effectiveness, and medical or economic developments. <br />f. We agree to provide an annual report of tax reportable claim payments to medical care <br />providers. <br />g. We agree to allow you to obtain a third party to conduct an on site claims audit at our <br />offices. Such claims audit will be limited to once per agreement year and the date(s) will <br />be mutually agreed upon. We agree to not unnecessarily delay the claims audit by not <br />mutually agreeing to a date. <br />h. We agree to administer all provisions contained in the Plan booklet/document adopted by <br />the Employer. <br />i. We agree to use care and diligence in the exercise of our powers and the performance of <br />our duties as Group Benefits Administrator hereunder but shall not be liable for any <br />mistake or judgment or other action taken in good faith or for any loss unless resulting from <br />our gross negligence. <br />J. We agree to process any written requests, issues or comments received from Eligible <br />Persons on appeals of denied benefits and forward the information to the Employer for <br />review and decision. <br />k. We agree upon receipt of the Employer's written decision of benefit appeals, to calculate <br />any amount due and payable and make payment, or issue a denial notice, all in accordance <br />with written instructions of the Employer. <br />I. We agree to notify stop loss carriers of potential claims and provide all reporting required <br />by stop loss carriers. <br />m. We agree to provide coordination of benefit services and pursue subrogation on behalf of <br />the employer, when applicable. <br />n. We agree to refund all amounts paid over the specific stop loss limit within ten (10) days <br />of approval by the stop loss carrier. <br /> <br />2 <br />