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2021-074B
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2021-074B
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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 />NIRS 17B:27B-6(b) <br />NJAC 11:23-3.1(c)(2)(iv) <br />NIRS 178:276-6(b) <br />NJAC 11:23-3.1(c)(2)(v) <br />MRS 178:27B -6(b) <br />NJAC 11:23-3.1(c)(2)(vi) <br />NIRS 17B:27B-6(b) <br />NJAC 11:23-3.1(c)(2)(vii) <br />MRS 17B:27B-6(c) <br />NJAC 11:23-3.1(c)(3)(i) <br />MRS 17B:27B-6(c) <br />NJAC 11:23-3.1(c)(3)(ii) <br />NIRS 17B:27B-6(c) <br />NJAC 11:23-3.1(c)(3)(iii) <br />Sponsor will be responsible for notifying EDH of modifications in the <br />Sponsor's benefit plans. <br />Sponsor will be solely responsible for the cost of any ineligible claims paid by <br />EDH. <br />Sponsor will be solely responsible for any liability incurred on account of any <br />overdue payments by EDH. <br />Sponsor will be solely responsible for procuring any reinsurance or stop -loss <br />insurance relative to the benefit plans under the Agreement. <br />EDH will maintain appropriate back-up systems against the loss of the <br />records. <br />EDH will establish and maintain appropriate financial controls. <br />Sponsor may at its sole expense employ an outside auditor to conduct any <br />claims audit under the Agreement. <br />MRS 176:2713-6(c) EDH hereby represents and warrants to Sponsor that EDH has, and during the <br />NJAC 11:23-3.1(c)(3)(iv) term of the Agreement will maintain, general liability insurance, valuable <br />papers insurance, errors and omissions coverage, and such other coverage as <br />required under NJAC 11:23-3.1(c)(3)(iv) in connection with EDH's <br />performance of its obligations under the Agreement. <br />MRS 1711:276-6(c) EDH will make all records referred to the Agreement, including, without <br />NJAC 11:23-3.1(c)(3)(v)&(vi) limitation, claims disbursements and experience records, available for the <br />Sponsor's inspection from time to time during normal business hours. In <br />addition, the claims disbursements and experience records will be available <br />at Sponsor's request, including monthly reports if requested. <br />NJAC 11:23-3.1(c)(3)(vii) To the extent applicable, EDH will prepare and provide to Sponsor all the data <br />for any prompt -pay reports as may be required for Sponsor to comply with <br />New Jersey law. No prompt -pay penalties are provided for under the <br />Agreement. <br />MRS 1713:276-7(b) Sponsor shall own the records generated by EDH pertaining to Sponsor, <br />NJAC 11:23-3.2(b) except that EDH shall retain the right to continuing access to books and <br />records to permit EDH to fulfill all of its contractual obligations to Sponsor. <br />MRS 1713:276-7(c) If the Agreement is canceled, EDH may, with the written agreement of <br />NJAC 11:23-3.2(c) Sponsor, transfer all records to a new administrator instead of retaining them <br />for five years. <br />MRS 1713:276-10 All funds remitted to EDH by Sponsor shall be held by EDH in a separate <br />NJAC 11:23-3.5 account maintained in the name of Sponsor or in a separate account <br />maintained jointly in the names of Sponsor and EDH. If funds have been <br />M <br />
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