06-B Health Insurance Contract - Laserfiche WebLink

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DEFINITIONS: The following ten'ns where used in this Agreement, have these meanings: we, us, or our - The TML Intergovernmental Employee Benefits Pool, known as the Group Benefits Administrator herein, or any subcontractor which it designates to perform the thnctions and meet the obligations to which it agrees in this Agreement. You or your - The Employer named in the Schedule. The Plan - The employee benefit plan which the Employer named in the Schedule has adopted to provide medical expense benefits to eligible persons, as defined, and which is attached to this Agreen~ent. ~,- Eligible Persons - Employees and dependents who are eligible for benefits under the Plan. You have adopted the Plan and asked us to administer the benefits provided by the Plan. Therefore, in consideration of the mutuat promises contained in this Agreement, it is agreed as follows. I. OUR DUTIES We agree to process all claims presented on behalf of eligible persons for the payment of benefits according to the terms of the Plan. We will administer benefits per your plan document unless authorized by you, in xwiting, to pay outside the plan guidelines. We will not process any claim which was incurred prior to the Effective Date shov~q~ in the Schedule, unless authorized by you in writing prior to determination. b. We agree to provide, at monthly intervals, a listing of all Plan benefits paid. One custom report is provided, at your request, at no cost per plan year. Subsequent custom reports will be billed as shown in the schedule. c. We agree to design, review and print standard forms to explain benefits to employees, standard enrollment cards, standard ID cards and one (1) standard benefit book every two (2) years. d. We agree to provide under~vriting services including (i) annual cost projections, (ii) cost projections for Plan modifications; and estimates of reserve amoonts required to fund the Plan on a cun'ent basis. e. We agree to provide assistance to you in designing your Plan benefits based on coverage adequacy, cost control effectiveness, and medical or economic developments. f. We agree to provide an annual report of tax reportable claim pa3nnents to medical care providers. g. We agree to allow you to obtain a third party to conduct an on site claims audit at our offices. Such claims audit will be limited to once per agreement year and the date(s) will be mutually agreed upon. We agree to uot unnecessarily delay the claims audit by not mutually agreeing to a date. h. We agree to administer all provisions contained in the Plan booklet/document adopted by the Employer. i. We agree to use care and diligence in the exercise of our powers and the performance of our duties as Group Benefits Administrator hereunder but shall not be liable for any mistake or judgment or other action taken in good faith or for any loss unless resolting from our gross negligence. j. We agree to process any ,,witten requests, issues or comments received l'?om Eligible Persons on appeals of denied benefits and forward the information to the Employer for review and decision. Page 2 oF 5