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12/06/2016 (2)
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12/06/2016 (2)
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Last modified
12/10/2020 1:47:03 PM
Creation date
2/21/2017 1:24:25 PM
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Meetings
Meeting Type
BCC Regular Meeting
Document Type
Agenda Packet
Meeting Date
12/06/2016
Meeting Body
Board of County Commissioners
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The Administrator shall provide claims processing services on behalf of theEmployer for all properly submitted claims, in accordance with the benefits <br />set forth in Exhibit "A", using funds solely supplied by the Employer, as set <br />forth in Exhibit "B". The Administrator shall furnish each claimant with an <br />explanation of each claim that is paid, rejected or suspended. <br />For purposes of this Agreement., the term "claim(s)" shall be definedas the <br />amount paid or payable by the Administrator to providers of services and/or <br />covered group members under this Agreement and the Group Health Plan, <br />and in conformity with any agreements the Administrator enters into with <br />such providers of services. <br />The Administrator shall administer Its established Cost Containment <br />Program and Utilization Benefits Management Programs, as selected by the <br />Employer and outlined in the Group Health Plan. <br />The Administrator shall make available its Preferred Provider Organization <br />Program(s) to covered group members and their covered dependents, as <br />set forth in the Group Health Pian. Any agreements between providers of <br />services and the Administrator are the sole property of the Administrator <br />Cl and the Administrator retains the right to the use and control thereof. <br />3.5 <br />Whenever the Administrator becomes aware of an overpayment under the <br />Group Health Plan, the Administrator shall make a diligent attempt to <br />recover such overpayment. In the event any part of an overpayment is <br />recovered, the Employer will receive a refund from the Administrator. The <br />Administrator shall notify the Employer whenever attempted recovery is <br />unsuccessful and the Administrator shall not be required to institute any <br />legal proceeding to recover such overpayment. <br />3.6 Records and Rpl2orts, r t <br />960904.1 <br />The Administrator agrees to establish, maintain and provide to the <br />Employer, records and reports generated as a result of the administration of <br />the Group Health Plan for the purposes of reporting claims experience and <br />conducting audits of operations. However, the Administrator will not provide <br />any report which contains individual group member identifiable medical <br />information, nor will the Administrator provide any information with regard to <br />5 <br />64 <br />
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