R2007-236 AUTHORIZING AGREEMENT WITH BLUE CROSS BLUE SHIELD OF ILLINOIS

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f �, � ' "` SECTION 7: CLAIM DISPUTE RESOLUTION ' 7.1 After eachaustion of all remedies offered by the Claim Administrator, a Covered Person may appeal all adverse determinations with the Employer. The Claim Administrator will cooperate in providing Claim information pursuant to Section 4 above. 7.2 On occasion the Claim Administrator may deny all or part of submitted Claims.The Claim Administrator will provide a full and fair review of any determination of a Claim, any determination of a request for pre-notification, and any other ' determination made in accordance with the benefits and procedures detailed in the Plan. SECTION 8: FINAL DETERMINATION OF CLAIMS/INQUIRIES The Employer retains the final authority and responsibility to establish and construe the terms and conditions of the Plan and to determine Covered Persons' eligibility. Certain claims and/or inquiries will be referred to the Employer for final review and determination in the following instances: 8.1 When Claims for services do not appear to qualify for payment under the Plan,claims or inquiries where there is a question of eligibility,claims where there is a question as to the amount of payment due,and claims involving litigation or the threat of litigation;and 8.2 When a Covered Person chooses to appeal adverse determinations with the Employer after eachaustion of all remedies offered by the Claim Administrator. SECTION 9: COOPERATION OF THE PARTIES The parties shall use their best efforts to cooperate with and assist each other, as applicable, in the performance of their duties '� under this Agreement. � SECTION 10: CERTIFICATE OF CREDITABLE COVERAGE The Claim Administrator,at the written direction of the Employer,shall issue a Certificate of Creditable Coverage consistent with the requirements under HIPAA. The Certificate of Creditable Coverage shall be based upon coverage under the Plan during the term of this Agreement and information provided to the Claim Administrator by the Employer. SECTION 11: INDEMNIFICATION 11.1 Claim Administrator indemnifies Employer. The Claim Administrator hereby agrees to indemnify and hold harmless the Employer and its directors, officers and employees against any and all loss, liability, damages, penalties and expenses, including attorneys' fees,or other cost or obligation resulting from or arising out of claims,lawsuits,demands,settlements or judgments with respect to the Plan or this Agreement resulting from or arising out of any acts or omissions of the Claim Administrator or its directors,officers or employees which have been adjudged to be(i)negligent,dishonest, fraudulent or criminal or(ii)in material breach of the terms of this Agreement;provided,however,notwithstanding anything herein to the contrary pursuant to Section 12.2 below,the Claim Administrator shall be responsible for the correction of Claim Payment and/or Net Claim Payment errors by the Claim Administrator. 11.2 Employer indemnifies Claim Administraton The Claim Administrator does not insure or underwrite the liability of the Employer under the Plan and has no responsibility for designing the terms of the Plan or the benefits to be provided thereunder.The Employer retains the ultimate responsibility for claims under the Plan and all expenses incident to the Plan, except as specifically undertaken in this Agreement by the Claim Administrator. The Employer agrees to indemnify and hold harmless the Claim Administrator and its directors,officers and employees against any and all loss,liability,damages, penalties and expenses,including attorneys'fees,or other cost or obligation resulting from or arising out of claims,lawsuits, demands,settlements or judgments brought against the Claim Administrator in connection with the design or administration of the Plan,unless the liability therefor was the direct consequence of the acts or omissions of the Claim Administrator or its directors, officers or employees and is adjudged to be (i) negligent, dishonest, fraudulent or criminal or (ii) in material breach of the terms of this Agreement; provided, however, notwithstanding anything herein to the contrary pursuant to Section 12.2 below, the Claim Administrator shall be responsible for the correction of Claim Payment and/or Net Claim Payment errors by the Claim Administrator. -10-