R95-141 AUTHORIZING APPLICATIONS FOR GROUP HEALTH INSURANCE COVERAGE

Home Browse Search

� H. The Claim Administrator in its sole discretion reserves the right to pay any benefits that are pay- able under the terms of this Agreement directly to the Covered Employee or to the Provider of the service. The Employer represents that it has communicated the provision specified in the paragraph above to its employees and that said provision is contained in the Employer's agreement with its employees to provide health care coverage. IV. COMPENSATION TO CLAIM ADMINISTRATOR A. The Employer will pay a service charge to the Claim Administrator as compensation for the pro- cessing of Claims and administrative and other services provided to the Employer. This service charge will be the following percentage(s) and/or amount(s) and will be applied in accordance with the provisions of this Agreement: 1.95% of Claim Payments through October 31, 1995; Effective November 1, 1995, 1.90% of Claim Payments; $2.30 per Covered Employee per month for the Administration of the Medical Services Advisory ("MSA") Program. The Claim Administrator shall be compensated for its administration of the reimbursement provi- sion by retaining 15% of any amounts recovered on behalf of the Employer. The service charge will be computed and payable in accordance with the Section below entitled "Claim Settlements." B. The service charge, which is guaranteed for a twelve (12) month period from the Effective Date of this Agreement has been determined in accordance with the Claim Administrator's current reg- � ulatory status and the existing benefit program. Should future legislation or administrative rule or regulation(i)obligate the Claim Administrator to pay any new taxes or other fees imposed upon or resulting from this Agreement,or(ii) mandate a new or modify a current benefit,then the Claim Administrator reserves the right, upon at least sixty (60) days written notice to the Employer to adjust the service charge within such twelve (12) month period. C. In addition, the Claim Administrator's compensation for its services under this Agreement shall include the difference between the aggregate Claim Payments reimbursed to the Claim Adminis- trator by the Employer under this Agreement and the net amounts paid to Providers by the Claim Administrator after giving effect to the Claim Administrator's Separate Financial Arrangements with Providers. V. TRANSFER PAYMENT In consideration of the Claim Administrator's obligations as set forth in this Agreement and at the end of each Transfer Payment Period, the Employer shall transfer to the Claim Administrator's account number#74-15516 at Bank of America Illinois an amount equal to the Transfer Payment Period Claim Payments plus the applicable service charge. For purposes of this agreement,the Transfer Payment Period shall be weekly. The Claim Administrator shall advise the Employer's Financial Division by telephone (at a telephone number to be furnished by the Employer prior to the effective date of this Agreement)of the amount of Claim Payments made pursuant to this Agreement for which reimburse- ment has not been previously made by Employer to the Claim Administrator, plus the applicable ser- vice charge. VI. CLAIM SETTLEMENTS A. Claim Settlements will be determined for each monthly period. Such period will be referred to � as the "Claim Settlement Period." The Claim Settlement will compare the total Transfer Pay- ments received by the Claim Administrator in the particular Claim Settlement Period to the sum of the following: - 3 - '