R99-108 AUTHORIZING APPLICATIONS

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� cerning Covered Persons.The Employer agrees to use best efforts in responding promptly and accurately to the Claim Administrator's requests for information and to require and facilitate its employees' cooperation in responding promptly and accurately to such requests. Further,to assure the continuing accuracy ofthe Claim Administrator's files,the Employer agrees that it is the Employer's responsibility to notify the Claim Administrator promptly of any change in the size of the Employer's work force or status of its employees that might effect the order of payment underthe MSP statute,such as information regarding working-aged persons who retire and changes in the size of the Employer's work force that place it in, or take it out of, the scope , of the MSP statute. If the Claim Administrator does not receive such information from the Em- ! ployer, the Claim Administrator will assume that all relevant factors remain unchanged and will process claims accordingly. The group acknowledges and agrees that the Claim Administrator will be using the information provided bythe Employer and Covered 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 status. 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 pam- phlet entitled "Information Regarding the Medicare Secondary Payer Statute" (also referred to as the"Disclosure Statement"), prepared by the BlueCross and BlueShield Association and re- viewed 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 organiza- tion, or by both, to the extent that such plan, fund or program was established or is maintained for the purpose of providing for its participants or their beneficiaries,through the purchase of in- surance or otherwise,medical/surgical or hospital care or benefits,or benefits in the event of sick- ness, 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 wel- fare benefit plan document may provide forthe allocation and delegation of responsibilitiesthere- under. 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 anyfiduciary or non-fiduciary responsibilities under the Plan or any other employee welfare bene- fit plan of the Employer is effective with respect to or accepted by the Claim Administrator. B. The Claim Administrator is not the plan administrator of the Employer's separate ERISA welfare benefit plan. Rather, the "Plan Administrator" means the administrator of the separate ERISA welfare benefit plan established by the Employer which is partially or fully implemented through this Agreement. "Named Fiduciary" means those persons appointed as such by the Employer under the separate ERISA welfare benefit plan established by it with certain fiduciary responsibi- lities with respect to the Employer's ERISA welfare benefit plan. The Claim Administrator 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 (in- cluding 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 Adminis- - 14 -