2023-130AD - Laserfiche WebLink

Home Browse Search

rendering services to the Covered Persons, each participating provider member of the Ameritas PPO Network agrees to accept the amount set forth in their respective fee schedule as payment in full for procedures listed on the fee schedules and further, that the participating providers have agreed to bill Covered Persons only for the cost of services not covered under the Plan. Section III. Obligations of Plan Sponsor Plan Sponsor or Plan Sponsor's subcontractor shall: A. Promptly and diligently provide eligibility information for Covered Persons under the Plan, on or after the Effective Date of this Agreement, to Ameritas in a format mutually agreed upon by Plan Sponsor and Ameritas. B. Provide benefit information, eligibility information and periodic (at least monthly) updates of additions, deletions and changes with regard to Covered Persons by an agreed upon medium. C. Designate personnel with authority to answer questions relative to eligibility so that accurate eligibility information is available to Ameritas upon request. D. Maintain and administer the Plan in compliance with ERISA or the PHSA, as applicable; provide discretionary authority and exercise control respecting Plan management and claims decisions. Section IV. Banking Arrangements During the term of this Agreement: A. All benefit payments made by Ameritas on behalf of the Plan will be issued by Ameritas on checks payable through Ameritas' bank of choice. B. Ameritas will send to Plan Sponsor, or, upon request and authorization, an entity designated by Plan Sponsor ("Designee"), the Weekly Paid/Denied Claim Report identified in Addendum D. Accompanying this report will be a cover letter setting forth the total amount paid as reflected by the report. Three (3) business days after sending, Plan Sponsor or Designee will pay or cause to be paid to Ameritas the amount listed in the letter in a mutually agreed upon format. Plan Sponsor will complete and provide all necessary authorizations to accommodate the payment. C. Failure to reimburse Ameritas in accordance with the above will result in interest being charged on the unpaid amount from the date due until fully paid at a rate equal to the lower of a) ten percent (10%) per year or, b) the maximum rate allowable by applicable usury laws and may result in the discontinuance of the Agreement in accordance with Section VI. Section V. Administrative Service Charge Schedule A. Except as otherwise provided hereafter, the administrative service charge for each month of