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05/11/2021
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05/11/2021
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8/16/2021 10:57:56 AM
Creation date
8/16/2021 10:54:54 AM
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Meetings
Meeting Type
BCC Regular Meeting
Document Type
Agenda Packet
Meeting Date
05/11/2021
Meeting Body
Board of County Commissioners
Board of County Commissioners
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EXHIBIT C <br />provided, unless a legitimate reason is provided and the purpose is not to delay payment, harass <br />the claimant, or discourage filing of claims. EDH shall not pay.only a part of a claim that has been <br />approved and is fully payable. <br />683A.088 Each claim paid by EDH from money collected for or on behalf of Sponsor must be paid by a check <br />or draft upon and as authorized by.Sponsor. <br />683A.0883(1-2) (1) The compensation paid to EDM for its services may be based upon premiums or charges <br />collected, on number of claims paid or processed or on another basis agreed upon by EDH and <br />Sponsor, except as provided in subsection (2) below. <br />(2) Compensation paid to EDH .may not be based upon or contingent upon: (a) The claim <br />experience of the policies which it handled; (b) The savings realized by EDH by adjusting, settling <br />or paying the losses covered by Sponsor <br />3. New Jersey. The Parties desire to supplement the Agreement to specifically reference certain <br />provisions of New Jersey 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 />MRS 176:276-6 The Agreement shall be retained as part of the official records of EDH for the <br />NJAC 11:23-3.1(b) duration of the Agreement and for five years thereafter. <br />NIRS 176:278-6(a) EDH will provide Sponsor the services described in the Agreement and will be <br />NJAC 11:23-3.1(c)(1) compensated as stated in the Agreement. <br />NIRS 17B:27B-6(b) Sponsor will be responsible for the provision of enrollment and eligibility <br />NJAC41:23-3.1(c)(2)(i) information to EDH. <br />MRS 17B:27B-6(b) Sponsor will be responsible to EDH to arrange for a preliminary or escrowed <br />NJAC 11:23-3.1(c)(2)(ii) deposit of funds by Sponsor as described in the Agreement, if any. <br />MRS 17B:27B-6(b) Sponsor will be responsible for the transmittal of funds from Sponsor to EDH for <br />NJAC 11-.23-3.1(c)(2)(iii) the purpose of paying claims as described in the Agreement. <br />MRS 17B:27B-6(b) Sponsor will be responsible for notifying EDH of modifications in the Sponsor's <br />NJAC 11:23-3.1(c)(2)(iv) benefit plans. <br />NIRS 1713:2713-6(b) Sponsor will be solely responsible for the cost of any ineligible claims paid by EDH. <br />NJAC 11:23-3.1(c)(2)(v) <br />MRS 178:276-6(b) Sponsor will be solely responsible for any liability incurred on account of any <br />NJAC 11:23-3.1(c)(2)(vi) overdue payments by EDH. <br />NIRS 17B:27B-6(b) <br />Sponsor will be solely responsible for procuring any reinsurance or stop -loss <br />NJAC 11:23-3.1(c)(2)(vii) <br />insurance relative to the benefit plans under the Agreement. <br />NJ RS 176:27B -6(c) <br />EDH will maintain appropriate.back-up systems against the loss of the records. <br />NJAC 11:23-3.1(c)(3)(i) <br />MRS 17B:27B-6(c) <br />EDH will establish and maintain appropriate financial controls. <br />NJAC 11:23-3.1(c)(3)(ii) <br />MRS 17B:27B-6(c) <br />Sponsor may at its sole expense employ an outside auditor to conduct any claims <br />NJAC 11:23-3.1(c)(3)(iii) <br />audit under the Agreement. <br />-3- 77 <br />
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