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<br />DEFINITIONS: The following tenns where used in this Agreement, have these meanings: <br /> <br />o We, us, or our - The TML Intergovernmental Employee Benefits Pool, known as the Group <br />Benefits Administrator herein, or any subcontractdr which it designates to perfonn the functions <br />and meet the obligations to which it agrees in this Agreement. <br /> <br />o You or your - The Employer named in the Schedule. <br /> <br />o The Plan - The employee benefit plan which the Employer named in the Schedule has adopted to <br />provide medical expense benefits to eligible persons, as defined, and which is attached to this <br />Agreement. <br /> <br />o Eligible Persons - Employees and dependents who are eligible for benefits under the Plan. <br /> <br />You have adopted the Plan and asked us to administer the benefits provided by the Plan. Therefore, in <br />consideration of the mutual promises contained in this Agreement, it is agreed as follows. <br /> <br />I. OUR DUTIES <br /> <br />a. <br /> <br />We agree to process all claims presented on behalf of eligible persons for the payment of <br />benefits according to the tenns of the Plan. We will administer benefits per your plan <br />document unless authorized by you, in writing, to pay outside the plan guidelines. We will <br />not process any claim which was incurred prior to the Effective Date shown in the <br />Schedule, unless authorized by you in writing prior to determination. <br />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 />We agree to design, review and print standard forms to explain benefits to employees, <br />standard enrollment cards, standard ID cards and one (I) standard benefit book every two <br />(2) years. <br />We agree to provide underwriting services including (i) annual cost projections, (ii) cost <br />projections for Plan modifications; and estimates of reserve amounts required to fund the <br />Plan on a current basis. <br />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 />We agree to provide an annual report of tax reportable claim payments to medical care <br />providers. <br />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 />We agree to administer all provisions contained in the Plan booklet/document adopted by <br />the Employer. <br />We agree to use care and diligence in the exercise of our powers and the perfonnance 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 />We agree to process any written requests, issues or comments received from Eligible <br />Persons on appeals of denied benefits and forward the infonnation to the Employer for <br />review and decision. <br /> <br />~ <br /> <br />b. <br /> <br />c. <br /> <br />d. <br /> <br />e. <br /> <br />f. <br /> <br />g. <br /> <br />h. <br /> <br />I. <br /> <br />J. <br /> <br />n.........., ....f'C <br />