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1991-124-RES WHEREAS, the City Council of the City of Paris, is desirous of providing health care for the City of Paris
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1991-124-RES WHEREAS, the City Council of the City of Paris, is desirous of providing health care for the City of Paris
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8/18/2006 4:33:29 PM
Creation date
4/12/2005 2:00:35 AM
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CITY CLERK
Doc Name
1991
Doc Type
Resolution
CITY CLERK - Date
12/9/1991
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<br />, <br /> <br />I <br /> <br />b. <br /> <br />. . <br />~nthly benefit experience reports, and <br /> <br />c. Those reports specified in Item Four of the current Exhibit to this <br />Agreement, if any. <br /> <br />2.10 Contractor will provide Purchaser copies of specific claim payment drafts upon <br />request; <br /> <br />2.11 Contractor shall evaluate late applicants for evidence of good health on behalf of <br />Purchaser; <br /> <br />2.12 Contractor shall maintain current individual benefit records on all Participants and <br />shall maintain the confidentiality of any medical information contained in such <br />records; <br /> <br />2.13 Contractor shall prepare IRS form 1099 reports on medical provider fees annually; <br /> <br />2.14 Contractor shall keep Purchaser informed with respect on non-routine "shock" claims <br />and matters of general interest including recurring administration problems, local <br />situations meriting review, and possible misuses of benefits; <br /> <br />2.15 Contractor shall refer to Purchaser any claim or class of claims Purchaser may specify <br />for consideration and final decision, to include: <br /> <br />a. Claims for services which do not appear to qualify for payment under the <br />Benefit Program, <br /> <br />b. Claims in which there is a question on the amount of payment due, <br /> <br />c. Claims involving any matter in controversy, and <br /> <br />d. Those claims or classes of claims specified in Item Three of the current <br />Exhibit to this Agreement, if any; <br /> <br />2.16 Contractor shall assist Purchaser in the analysis and resolution of disputed claims, <br />provided however, that such assistance shall in no way include, or be considered to <br />include or constitute, legal advice or opinions; and <br /> <br />2.17 Underwriting services will not be provided unless specifically identified in Item Two <br />of the Exhibit. Any such services provided will include required certifications by a <br />qualified actuary; and <br /> <br />2.18 Contractor shall also provide those services specified in Item Two of the current <br />Exhibit to this Agreement, if any. <br /> <br />3 <br />
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