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(See provisions of this Agreement regarding"CLAIM ADMINISTRATOR'S SEPARATE FINAN- <br /> • CIAL ARRANGEMENTS WITH PROVIDERS.") <br /> D. "Claim Payment" means the benefit provided by the Claim Administrator, upon submission <br /> of a Claim, in accordance with the benefits specified in the Plan. All Claim Payments shall be <br /> calculated on the basis of the Provider's Eligible Charge for Covered Services rendered to the <br /> Covered Person, irrespective of any separate financial arrangement between the Claim Admin- <br /> istrator and the particular Provider. (See provisions of this Agreement regarding "CLAIM AD- <br /> MINISTRATOR'S SEPARATE FINANCIAL ARRANGEMENTS WITH PROVIDERS.") <br /> E. "Coinsurance" means a percentage of an eligible expense that a Covered Person is required <br /> to pay toward a Covered Service. <br /> F. "Covered Employee" means the person to whom coverage under the Plan has been ex- <br /> tended by the Employer and to whom the Claim Administrator has directly or indirectly issued <br /> an identification card bearing the number of the Employer. For purposes of providing benefits <br /> under the Plan, Covered Employee does not mean any person who has selected Medicare as <br /> his/her primary coverage. <br /> G. "Covered Person" means the Covered Employee and such employee's legal spouse and/or <br /> unmarried dependent children as specified in the Plan. <br /> H. "Covered Service" means a service or supply specified in the Plan for which benefits will be <br /> provided. <br /> I. "Inpatient" means the Covered Person is a registered bed patient and treated as such in a <br /> health care facility. <br /> J. "Medicare Secondary Payer" or "MSP" means those provisions of the Social Security Act <br /> • set forth in 42 U.S.C. �1395 y (b), and the implementing regulations set forth in 42 C.F.R. Part <br /> 411,as amended,which regulate the manner in which certain employers may offer group health <br /> care coverage to Medicare-eligible employees, their spouses and, in some cases, dependent <br /> children. (See Section XVI. of this Agreement regarding Medicare Secondary Payer ("MSP") <br /> Provisions.) <br /> K. "Net Claim Payment" means the net benefit payment calculated by the Claim Administrator, <br /> upon submission of a Claim, in accordance with the benefits specified in the Plan.All Net Claim <br /> Payments shall be calculated on the basis of the Provider's Eligible Charge for Covered Ser- <br /> vices rendered to the Covered Person, less the ADP if applicable, irrespective of any separate <br /> financial arrangement between the Claim Administrator and the particular Provider. (See Sec- <br /> tion XV. of this Agreement regarding the Claim Administrator's Separate Financial Arrange- <br /> ments with Providers.) <br /> L. "Provider"means any health care faciliry, person or entity duly licensed to render Covered Ser- <br /> vices to a Covered Person. <br /> M. "Provider's Eligible Charge" means (a) in the case of a Provider which has a written agree- <br /> ment with the Claim Administrator to provide care to Covered Persons at the time Covered Ser- <br /> vices are rendered, such Provider's Claim Charge for Covered Services and (b) in the case of <br /> a Provider which does not have a written agreement with the Claim Administrator to provide <br /> care to Covered Persons at the time Covered Services are rendered, such Provider's Claim <br /> Charge for Covered Services, not to exceed the reasonable charge therefor as reasonably de- <br /> termined by the Claim Administrator. <br /> • <br /> - 13 - <br />