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R2000-207 AUTHORIZING APPLICATIONS
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R2000-207 AUTHORIZING APPLICATIONS
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Last modified
3/29/2016 11:49:26 AM
Creation date
3/29/2016 11:49:24 AM
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Resolution/Ordinance
Res Ord Num
R2000-207
Res Ord Title
AUTHORIZING APPLICATIONS FOR GROUP HEALTH INSURANCE COVERAGE
Approved Date
10/16/2000
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E. The Employer further acknowiedges that the Claim Administrator may make Claim Payments �, <br /> after the Tentative Final Settlement is computed for services rendered or fumished prior to the ''� <br /> termination date or as otherwise specified in Section XIII. paragraph B. above, including, but I <br /> not limited to, Claim Payments made in accordance with MSP laws.The Claim Administrator <br /> will bill the Employer periodically, but not more frequently than monthly,for the total Net Claim <br /> Payments and the service charges applicable to the processing of such Claims after the ter- <br /> mination date of this Agreement. All sums due the Claim Administrator will be paid in full by <br /> the Employer no later than ten (10)days after the Employer's receipt of the Claim Administra- <br /> tor's invoice for such payment. <br /> XIV. RELATIONSHIP OF PARTIES <br /> A. The Claim Administrator is an independent contractor with respect to the Employer, and noth- <br /> ing in this Agreement shall create, or be construed to create,the relationship of Employer and <br /> employee between the Claim Administrator and the Employer, nor shall the Employer's <br /> agents, officers or employees be considered or construed to be considered employees of the <br /> Claim Administrator for any purpose whatsoever. <br /> B. It is understood and agreed that nothing contained in this Agreement shall confer or be <br /> construed to confer any benefit on persons who are not parties to this Agreement including, <br /> but not limited to, employees of the Employer and their dependents. <br /> C. Section XIX. below entitled"ERISA"contains further information regarding the relationship of <br /> the parties hereto. <br /> XV. COVERED PERSON/PROVIDER RELATIONSHIP <br /> A. The choice of a Provider is solely the choice of the Covered Person and the Claim Administra- <br /> tor will not interfere with the Covered Person's relationship with any Provider. <br /> B. It is expressly understood that the Claim Administrator does not itself undertake to furnish hos- <br /> pital or medical service, but solely to make payment to a Provider for the Covered Services <br /> received by Covered Persons. The Claim Administrator is not in any event liable for any act <br /> or omission of any Provider or the agent or employee of such Provider, including, but not lim- <br /> ited to, the failure or refusal to render services to a Covered Person. Professional services <br /> which can only be legally performed by a Provider are not provided bythe Claim Administrator. <br /> Any contractual relationship between a Provider and the Claim Administrator shall not be <br /> construed to mean that the Claim Administrator is providing professional service. <br /> C. The use of an adjective such as Approved,Administrator, Participating or In-Network in modi- <br /> fying Provider shall in no way be construed as a recommendation, referral or any other state- <br /> ment as to the ability or quality of such Provider. I n addition,the omission,non-use or non-des- <br /> ignation of Approved, Administrator, Participating, In-Network or any similar modifier or the <br /> use of a term such as Non-Approved, Non-Administrator, Non-Participating, or Out-of-Net- <br /> work should not be construed as carrying any statement or inference, negative or positive, <br /> as to the skill or quality of such Provider. <br /> D. Each Provider provides Covered Services only to Covered Persons and does not deal with <br /> or provide any services to the Employer (other than as an individual Covered Person) or the <br /> Plan. <br /> The Employer represents that it has included the provision stated in this Section XV. in its Plan <br /> -- Document. <br /> XVI. INFORMATION AND MEDICAL RECORDS <br /> A. All Claim information, including, but not limited to, medical records, received by the Claim <br /> Administrator in the performance of its duties hereunder will be kept confidential by the Claim <br /> - 9 - <br />
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