R2000-207 AUTHORIZING APPLICATIONS

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ered Persons to update the Claim Administrator's files, and will also forward this information to HCFA so that HCFA can revise its file to reflect relevant changes in primary/secondary sta- tus... The Claim Administrator may, in its sole discretion, discontinue its participation in the Data Match system as described above. Nothing in this Agreement shall be construed as obligating the Claim Administrator to continue its participation in the Data Match system. C. Disclosure Statement The Employer acknowledges that the Claim Administrator has furnished it with a copy of a pamphlet entitled "Information Regarding the Medicare Secondary Payer Statute" (also re- ferred to as the"Disclosure Statement"),prepared by the BlueCross and BlueShield Associa- tion and reviewed by HCFA, which administers Medicare. XIX. ERISA A. As defined in Section 3 of ERISA,the term"employee welfare benefit plan"includes any plan, fund or program which is established or maintained by an employer or by an employee orga- nization, or by both,to the extent that such plan, fund or program was established or is main- ' tained for the purpose of providing for its participants or their beneficiaries, through the pur- chase of insurance or otherwise medical sur ical or hos ital care or benefits or benefits in � / 9 P , the event of sickness, accident or disability. The Employer hereby acknowledges (i) that an employee welfare benefit plan must be established and maintained through a separate plan document which may include the terms hereof or incorporate the terms hereof by reference, and (ii)an employee welfare benefit plan document may provide for the allocation and delega- tion of responsibilities thereunder. However, notwithstanding anything contained in the Plan or any other employee welfare benefit plan document of the Employer,the Employer agrees that no allocation or delegation of any fiduciary or non-fiduciary responsibilities under the Plan or any other employee welfare benefit plan of the Employer is effective with respect to or ac- cepted by the Claim Administrator. B. The Claim Administrator is not the plan administrator of the Employer's separate ERISA wel- fare benefit plan. Rather, the "Plan Administrator" means the administrator of the separate ERISAwelfare benefit plan established bythe Employerwhich is partially orfully implemented through this Agreement. "Named Fiduciary" means those persons appointed as such by the Employer underthe separate ERISA welfare benefit plan established by it with certain fiducia- ry responsibilities with respect to the Employer's ERISA welfare benefit plan. The Claim Ad- ministrator is not a named fiduciary with respect to the Employer's separate ERISA welfare benefit plan."Sponsor"means the Employer, as the plan sponsor of its ERISA welfare benefit plan. C. Section 402(c)(2) of ERISA provides that an employee welfare benefit plan may provide that a named fiduciary or a fiduciary designated by a named fiduciary pursuant to a plan procedure (including a plan administrator)may employ one or more persons to render advice with regard to any responsibilities such fiduciary has under the ERISA welfare benefit plan.The Claim Ad- ministrator's responsibilities hereunder are intended to be limited to those of a contract claims administrator rendering adviceto and administering claims on behalf ofthe plan administrator of the Employer's plan. As such,the Claim Administrator is intended to be a service provider but not a fiduciary with respect to the Employer's ERISA welfare benefit plan. The Employer represents that its ERISA welfare benefit plan contains the plan procedure described above ^ . regarding the designation of responsibilities under a plan,and accordingly,the Claim Adminis- trator may, pursuantto Sections 402(c)(2) and 405(c)(1)(B) of ERISA, render advice with re- spect to claims and administer claims on behalf of the plan administrator of the Employer's ERISA benefit plan. The Claim Administrator has no other authority or responsibility with re- spect to Employe�'s employee benefit plan. - 15 -