R96-148 AUTHORIZING APPLICATIONS

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• VI. CLAIM SETTLEMENTS A. A Claim Settlement shall be determined for each monthly period. Such period will be referred to as the "Claim Settlement Period." The Claim Settlement shall reflect the sum of the following: 1. All Net Claim Payments calculated on the basis of Claim Payments paid by the Claim Admin- istrator in the particular Claim Settlement Period. 2. All Net Claim Payments calculated on the basis of Claim Payments paid by the Claim Admin- istrator in prior Claim Settlement Periods that have not been included in a prior Claim Settle- ment. 3. The service charges specified in section IV. of this Agreement The sum of 1., 2., and 3. above shall be referred to as the Claim Settlement Total. B. If, within the Claim Settlement Period, the Claim Settlement Total exceeds the Post Payments, the Employer will pay the difference to the Claim Administrator. The Claim Settlement will be de- termined within sixty (60) days from the last day of the Claim Settlement Period. The Claim Ad- ministrator will notify the Employer in writing of the results of the Claim Settlement.Any sums due the Claim Administrator will be paid by the Employer within ten (10) days from the date the Claim Administrator notifies the Employer. C. If, within the Claim Settlement Period,the Post Payments exceed the Claim Settlement Total,the Claim Administrator may, at its option, pay such difference to the Employer, apply the difference against amounts then owed the Claim Administrator by the Employer or authorize a reduction equal to such difference from the next Claim Settlement due the Claim Administrator from the Employer. VII. CLAIM PAYMENTS, NET CLAIM PAYMENTS, AUDITS AND CORRECTIONS OF ERRORS � A. Upon receipt of a Claim,the Claim Administrator will make a Claim Payment provided that all pay- ments due the Claim Administrator under the terms of the Agreement are paid when due, and provided further, that the Employer performs all of its other obligations under the Agreement. B. Any reasonable determination by the Claim Administrator in adjudicating a Claim under the Agreement that a Covered Person is entitled to a Net Claim Payment is conclusive evidence of the liability of the Employer to the Claim Administrator for such Net Claim Payment pursuant to section above entitled "Claim Settlements." C. During the term of the Agreement and within one hundred eighty(180)days after the termination of the Agreement,the Employer may, upon at least thirty(30)days prior written notice to the Claim Administrator, conduct reasonable audits of the Claim Administrator's records in regard to Claim Payments and Net Claim Payments made under the Agreement. All such audits shall be subject to the Claim Administrator's external review procedures and guidelines, a copy of which shall be furnished to the Employer upon written request to the Claim Administrator. D. Any errors identified in Claim Payments and Net Claim Payments will be promptly corrected by the Claim Administrator subject to the terms and conditions of the Agreement. The Employer will assist and cooperate with the Claim Administrator in recovering errors in Net Claim Payments to Covered Persons but the responsibility for such errors in Net Claim Payments shall ultimately be the Claim Administrator's,limited to the Claim Administrator's making an equitable adjustment to the Employer's account. However, the Claim Administrator shall be responsible only for the correction of errors identified in specific Claim Payments and Net Claim Payments and shall not be responsible for errors calculated to exist in a population of Claim Payments and Net Claim Payments on the basis of a sample drawn from that population. Further, the Claim Administrator • has the right to implement reasonable administrative practices in the administration of the Agree- ment. Minor deviations in Claim Payments and Net Claim Payments from the provisions of the Agreement as a result of such reasonable administrative practices shall not be considered errors. - 4 -