2023-098B - Laserfiche WebLink

Home Browse Search

following the expiration or termination of this Agreement will be subject to the Employer's continued funding of claims payment. "Run out claims" refers to those claims incurred for services performed prior to the termination of this Agreement, but not yet paid and/or not submitted for payment to BCBSF prior to the termination of this Agreement. There is a separate and distinct Administrative Fee for BCBSF providing administrative services to pay run out claims. This is set out in Exhibit B. Section V: Miscellaneous Provisions A. It is understood that the Employer retains all final authority and responsibility for the Plan and its operation including, but not limited to, the benefits structure of the Plan, claims payment decisions, medical management decisions, compliance with the requirements of the COBRA, compliance with the requirements of ERISA, compliance with the requirements of HIPAA (Health Insurance Portability Administration Act of 1996), and compliance with any other state and federal law or regulation applicable to the Employer or the administration of the Plan and that BCBSF is empowered to act on behalf of the Employer in connection with the Plan only as expressly stated in this Agreement or as mutually agreed to in writing by BCBSF and the Employer. B. The Employer agrees to defend, indemnify and hold harmless BCBSF and its Designated Agent, from any and all claims, lawsuits, settlements, judgments, costs, penalties, liabilities and expenses, including reasonable attorneys' fees (for attorneys chosen by BCBSF), resulting from or arising out of, based on or in connection with any third party claim relating to this Agreement or Employer's Group Health Plan or the Plan, unless it is determined that the liability therefore was the direct consequence of criminal conduct, fraud, or willful misconduct on the part of BCBSF and its Designated Agent. Employer agrees to hold harmless and indemnify BCBSF and its Designated Agent for any penalties fees or costs incurred in connection with an alleged or actual failure by the Employer to qualify as grandfathered. BCBSF has no liability under Employer's Group Health Plan for Claims Amounts. Employer is, at all times, liable for the Claims Amounts (subject to any BCBSF obligations under the Stop -Loss Insurance Addendum if Employer has obtained Stop -Loss Insurance through BCBSF or a BCBSF affiliate), even where BCBSF is otherwise liable to Employer for indemnification under this Section (and BCBSF's liability under this Section shall be limited to amounts in excess of Claims Amounts). Employer agrees to hold BCBSF harmless for any claims amounts that are not reimbursed by any Stop -Loss Insurance carrier that is not affiliated with BCBSF. Employer's obligations are only to the limits set forth in section 768.28, Florida Statutes as of the time of the Effective Date of this Agreement. BCBSF agrees to indemnify and hold harmless Employer from any and all claims, lawsuits, settlements, judgments, costs, penalties, liabilities and expenses, including reasonable attorney's fees (for attorneys chosen by Employer), arising out of or related to the Plan or this Agreement, but only if resulting from BCBSF's and its Designated Agent's criminal conduct, fraud, or willful misconduct. C. Any of the functions to be performed by BCBSF under this Agreement may be performed by BCBSF or their Designated Agent or any of their respective subsidiaries or affiliates, and any reference in Section V. B. to BCBSF, their Designated Agent, and/or their directors, officers and employees shall also include such an affiliate or subsidiary, their directors, officers or employees. 16