R2000-207 AUTHORIZING APPLICATIONS

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Administrator and except for reasonable necessary use by the Claim Administrator in connec- tion with the performance of its duties hereunder, the Claim Administrator shall not disclose such confidential Claim information without the authorization of the Covered Person or as otherwise required or permitted by applicable law. B. The Claim Administrator shall release to the Employer Claim information regarding the provi- sion of Covered Services to Covered Persons and copies of records to the extent necessary to enable the processing of Claims or the response to a Provider or a Covered Person's com- plaint or to an appeal of the denial of a Claim reviewed by the Claim Administrator and the Employer.Any information so obtained by the Employer shall be kept confidential, as required by applicable state and federal law. C. It is the Covered Person's responsibility to ensure that any Provider, Blue Cross and Blue Shield Plan, insurance company, employee benefit association, governmental body or pro- gram, or any other person or entity, having knowtedge of or records relating to (1) any illness or injury for which a Claim or Claims for benefits are made under the Plan, (2} any medical history which might be pertinent to such illness, injury, Claim or Claims, or (3) any benefits or indemnity on account of such illness or injury or on account of any previous illness or injury which may be pertinent to such Claim or Claims,furnish to the Claim Administrator,at any time upon its request, any and all information and records (including copies of records) relating to such illness, injury, Claim or Claims. In addition, the Claim Administrator may furnish similar information and records (or copies of records)to other Providers, Blue Cross and Blue Shield Plans,•insurance companies, governmental bodies or other entities providing insurance-type benefits requesting the same. It is also the Covered Person's responsibility to furnish to the Employer and/or Claim Administrator information regarding the Covered Person's becoming eligible for Medicare, termination of Medicare eligibility or any change in Medicare eligibility ', status in order that the Claim Administrator be able to make Claim Payments in accordance with MSP laws. The Employer represents that it has included the provision stated in this Section XVI. in its Plan Document. ' XVII. CLAIM ADMINISTRATOR'S SEPARATE FINANCIAL ARRANGEMENTS WITH PROVIDERS , All amounts payable to the Claim Administrator by the Employer for Claim Payments provided by , the Claim Administrator and applicable service charges pursuant to the terms of this Agreement and all required deductible and Coinsurance amounts under this Agreement shall be calculated on the basis of the Provider's Eligible Charge tess the ADP, unless otherwise directed in writing by the Employer,for Covered Services rendered to a Covered Person,irrespective of any separate ' financial arrangement between any Administrator Provider or the Employer and the Claim Admin- I istrator. ' The Employer acknowledges that the Claim Administrator has contracts with certain Providers � ' ("Administrator Providers'�forthe provision of,and payment for, health care services to all persons il entitled to health care benefits under individual certificates, agreements and contracts to which the Claim Administrator is a party, including the Covered Persons under this Agreement, and that � pursuantto the Claim Administrator's contracts with Administrator Providers,under certain circum- stances described therein,the Claim Administrator may receive substantial payments from Admin- ,I istrator Providers with respect to services rendered to all such persons for which the Claim Admin- , istrator was obligated to pay Administrator Providers, or the Claim Administrator may pay �I — = Administrator Providers less than their Claim Charges for services, by discounts or otherwise, or ', may receive from Administrator Providers other allowances under the Claim Administrator's con- '� tracts with them. The Employer acknowledges that in negotiating the service charges set forth in I, this Agreement,it has taken into consideration that the Claim Administrator may receive such pay- ', ments, discounts and/or other allowances during the term of this Agreement and that the service ', - 10 -