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2021-074B
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Entry Properties
Last modified
6/22/2021 12:13:29 PM
Creation date
6/11/2021 3:23:37 PM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
05/11/2021
Control Number
2021-074B
Agenda Item Number
12.D.1.
Entity Name
Employer Direct Healthcare, LLC
Subject
Surgeryplus Services Agreement
Addition of SurgeryPlus Benefit as Optional Benefit
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DocuSign Envelope ID: 29EAB906-1936-4BAB-83BE-97C974F00293 <br />covered by the Plan shall have no greater rights to interest or other remedies against the EDH or any third <br />party administrator than as otherwise afforded them by law. Sponsor's required written notice shall be <br />promptly displayed in the summary plan description or elsewhere in the Plan Documents, and shall be <br />communicated to individuals covered by the benefit plan within sixty (60) days from the date their <br />coverage becomes effective, upon each republication of the summary plan description, and in any case <br />not less than every five (5) years in a manner calculated to be received and understood by the average <br />individual covered by the benefit plan. <br />5. Nevada. The Parties desire to supplement the Agreement to specifically reference certain <br />provisions of Nevada law applicable to third party administrators and to comply with those laws to the extent <br />applicable and not preempted by federal law, as follows: <br />683A.0868 If EDH establishes a panel of providers of health care or contracts with an organization that <br />establishes a panel of providers of health care, EDH shall not charge a provider of health care <br />or such an organization: (a) any fee to include the name of the provider of health care on the <br />panel; or (b) any other fee related to establishing the provider of health care as a provider on <br />the panel. If EDH violates this provision, EDH shall pay to the provider of health care or <br />organization, as appropriate, an amount that is equal to twice the fee charged to the provider <br />of health care or the organization. A court shall award costs and reasonable attorney's fees <br />to the prevailing party in any action brought to enforce this provision. In addition to any such <br />relief, if EDH violates this provision, the Nevada Division of Insurance shall require EDH to <br />suspend the prohibited activities until EDH, as determined by the Nevada Division of <br />Insurance: (a) complies with the provisions of this section; and (b) refunds to all providers of <br />health care or organizations, as appropriate, all fees obtained by EDH in violation of this <br />provision. <br />683A.405 EDH shall, upon a contracted provider's request, submit to the provider at the time the <br />contract is made a copy of the schedule of payments applicable to that provider, or at any <br />other time within seven (7) days of a provider's request. <br />683A.087 EDH may advertise the insurance which it administers, if any, only after it receives the <br />approval of Sponsor. <br />683A.0873(1) EDH shall maintain at its principal office adequate books and records of all transactions <br />between itself, Sponsor and the individuals covered by the plan. The books and records must <br />be maintained in accordance with prudent standards of recordkeeping for insurance and with <br />regulations of the Commissioner of the Nevada Division of Insurance ("Commissioner"I for a <br />period of five (5) years after the transaction to which they respectively relate. After the five <br />(5) year period, EDH may remove the books and records from Nevada, store their contents on <br />microfilm or return them to Sponsor. <br />683A.0873(2) The Commissioner may examine, audit and inspect books and records maintained by EDH <br />under the provisions of this section to carry out the provisions of NRS 679B.230 to 679B.300, <br />inclusive. <br />683A.0873(3) The names and addresses of persons covered by the plan or any other material which is in the <br />books and records of EDH are confidential except when used in proceedings against EDH. <br />01 <br />
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