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<br />o. We agree to refund all amounts paid over the aggregate ,top loss attachment point within <br />ten (10) days of approval by the stop loss carrier. <br /> <br />p. We agree to provide precertification, continued stay review, discharge planning and large <br />case management as needed. <br />q. We agree to use the HealthChex auto-audit to review your claims at no additional cost, as <br />directed by you on Attachment B to this Agreement. <br />r. We agree to receive claims electronically for your eligible persons to the extent providers <br />are capable of electronic submission. <br />s. We agree to maintain claims processing data on microfilm or optical disk for three (3) <br />years and provide you with copies of this data for individual requests within two (2) <br />business days following receipt. <br /> <br />II. YOUR DUTIES <br /> <br />a. You agree to establish an arrangement with your bank whereby Federal Funds will be <br />transferred from your bank account to our bank account in accordance with Attachment A, <br />which is incorporated and made a part of this Agreement. The amount of funds requested <br />will represent the amount of funds advanced in payment of Plan benefits. If transfer of <br />funds is not accomplished we may, at our option, take any or all ofthe following actions: <br />(i) suspend benefit payment without notice; <br />(ii) assess interest on the unpaid amount at a rate not to exceed the maximum allowed <br />bylaw. <br />(iii) terminate this Agreement immediately by written notice to you. <br />b. You agree to provide us in a timely fashion all information and assistance we may need to <br />properly administer the Plan. <br />c. You agree to verify according to your plan document, the eligibility of any persons who <br />request coverage under your plan. Your verification of eligibility will be indicated on the <br />enrollment record in the space provided for "Employer Acceptance". Once accepted by <br />you and the enrollment record received by us, those persons will be considered eligible <br />persons. <br />d. You agree to remit any premium for stop loss, life or other insured contracts by the <br />twentieth (20th) of each month and understand we do not advance premiums in your behalf. <br />e. You agree that if we or any of our agents or employees are subject to any fine, penalty, <br />loss, damage, cost, expense or legal fee because of our administration of the Plan in good <br />faith according to the terms of the Plan document, you will payor reimburse us for any <br />such fine, penalty, loss, damage, cost, expense or legal fee. In the event current revenues <br />are inadequate to fund the obligation at the time it is determined, you agree to take the <br />appropriate budgetary action sufficient to pay the obligation. <br />f. You agree to pay us a monthly service charge determined by multiplying the Monthly <br />Service Charge shown in the Schedule of this Agreement by the number of employees <br />covered under the Plan as of the first day of each calendar month commencing on the <br />Effective Date of this Agreement. Payment shall be due as of the first day of each calendar <br />month and shall be payable no later than the twentieth (20th) ofthe month. <br />g. You agree to act on all benefit appeals in accordance with the provisions outlined by the Plan. <br /> <br />3 <br />