05/11/2021 - Laserfiche WebLink

Home Browse Search

EXHIBIT C REGULATORY ADDENDUM This Regulatory Addendum (this "Addendum") is made effective as of January 1, 2021 by and between Employer Direct Healthcare, LLC, a Delaware limited liability company with its principal place of business located at 2100 Ross Avenue, Suite 550, Dallas, Texas 75201 ("EDH") and the City of Sebring, a Florida municipal corporation, with its principal place of business located at 368 South Commerce Avenue, Sebring, Florida 33870 ("Sponsor"). EDH and Sponsor are referred to collectively as the "Parties" and individually as a "Party." This Addendum is intended by the Parties to supplement the Plan Agreement (the "Agreement"), dated effective as of January 1, 2021. The Parties desire to supplement the Agreement to specifically reference certain provisions of law applicable to third -party administrators and to comply with those laws. Accordingly, pursuant to the terms and conditions of the Agreement and in consideration of the mutual promises contained herein, the Parties agree as follows: 1. Michigan. The Parties desire to supplement the Agreement to specifically reference certain provisions of Michigan law applicable to third -party administrators and to comply with those laws to the extent applicable and not preempted by federal law, as follows: In Michigan, Sponsor shall provide written notice to each individual covered by the Plan of the following information, with respect to services provided by EDH in relation to the Plan: (a) what benefits are being provided; (b) of changes in benefits; (c) the fact that individuals covered by the Plan are not insured or are only partially insured, as the case may be; (d) if the Plan is not insured, the fact that in the event the Plan or Sponsor does not ultimately pay medical expenses that are eligible for payment under the Plan for any reason, the individuals covered by the plan may be liable for those expenses; (e) the fact that the EDH or any third -party administrator merely processes claims and does not insure that any medical expenses of individuals covered by the Plan will be paid; (f) the fact that complete and proper claims for benefits made by individuals covered by the Plan will be promptly processed but that in the event there are delays in processing claims, the individuals covered by the Plan shall have no greater rights to interest or other remedies against the EDH or any third -party administrator than as otherwise afforded them by law. 2. Nevada. The Parties desire to supplement the Agreement to specifically reference certain provisions of Nevada law applicable to third -party administrators and to comply with those laws to the :extent applicable and not preempted by federal law, as follows: 683A.087 EDH may advertise the insurance which it administers, if any, only after it receives the approval of Sponsor. 683A.0873(1) EDH shall maintain at its principal office adequate books and records of all transactions between itself, Sponsor and the individuals covered by the plan. The books and records must be maintained in accordance with prudent standards of recordkeeping for insurance and with regulations of the Commissioner of the Nevada Division of Insurance ("Commissioner" 1 for a period of five (5) years after the transaction to which they respectively relate. After the five (5) year period, EDH may remove the books and records from Nevada, store their contents on microfilm or return them to Sponsor. 683A.0873(2) The Commissioner may examine, audit and inspect books and records maintained by EDH under the provisions of this section to carry out the provisions of NRS 6798.230 to 6798.300, inclusive. 683A.0873(3) The names and addresses of persons covered .by the plan or any other material which is in the books and records of EDH are confidential except when used in proceedings against EDH. 683A.0873(4) Sponsor may inspect and examine all books and records to the extent necessary to fulfill all contractual obligations to insured persons, subject to restrictions in the. written agreement between Sponsor and EDH. -1- 75