R98-142 AUTHORIZING AGREEMENT - Laserfiche WebLink

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Article 2 General Responsibilities 2.01 Standards and Procedures VISTA shall administer Employees' reimbursement requests in accordance with the Plan Document and shall have full authority and control in all matters pertaining to the adjudication, handling, investigation and administration of claims for reimbursement. VISTA is not, however, the designated Administrator for purposes of the Employee Retirement Income Security Act of 1974(ERISA). VISTA sha11 make its file for each individual claim available for review by the Employer and shall provide the Employer with the following: a.) the total of the amount paid out in claims for any day when requested; b.) a monthly Flexible Spending Fund Report and a Flex Funding Billing Report showing the current status for each Eligible Employee's Flexible fund spending account. c.) monthly, an individual Statement of Account for each Eligible Employee for the selected period. d.) All forms necessary for the efficient operation of the flexible compensation program. 2.02 Claims VISTA shall, except in the event of termination for Nonpayment/Partial Payment, administer Employee's covered claims which are incurred during the Term(s) of this Contract and shall process these claims on behalf of the Employer. VISTA shall, following Normal Ternunation, and may, following NonpaymentlPartial Payment Ternunation, continue to process IBNR Claims. As part of the process, VISTA shall: a.) examine all cla.ims of any Eligible Employees requesting benefits under the Plan. b.) conduct an investigation of the reported cla.im(s) qualifying under this Section 2.02 to the extent deemed necessary by VISTA, to adjudicate and handle to a conclusion, those claims,that VISTA, in its sole judgement,believes the Employer is legally obligated to pay. c.) perform all reasonable and necessary administrative and clerical work in connection with processing such Eligible Employees' claims, including preparation of checks or drafts drawn against funds of the Employer. d.) keep such records and files of benefit payments and denials as is prudent. With respect to benefit claim denials or reductions, notify applicable persons thereof and of such rights of review as may exist pursuant to applicable law. 2.03 Dispute Resolution VISTA, while processing Coverage(s) under this contract, is subrogated to all rights of the Employer relating to any disputed claim(s) and is not obligated to institute or become involved � in any litigation concerning such Claim(s). Selection of defense attorneys by VISTA when a claim or loss is contested and is to be litigated, shall be done only with the approval of the Corporation Counsel or designee of the Employer.