R95-141 AUTHORIZING APPLICATIONS FOR GROUP HEALTH INSURANCE COVERAGE

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• 1. All Claim Payments provided by the Claim Administrator in the particular Claim Settlement Period. 2. All Claim Payments provided by the Claim Administrator in prior Claim Settlement Periods that have not been included in a prior Claim Settlement. 3. The service charge as computed on the total of 1. and 2. above. The sum of VI. A. 1., 2., and 3. above shall be referred to as the Claim Settlement Total for that Claim Settlement Period. B. If within the Claim Settlement Period,the Claim Settlement Total exceeds the Transfer Payments received in the particular Claim Settlement Period, the Employer will pay the difference to the Claim Administrator. The Claim Settlement will be determined within sixty(60)days from the last day of the Claim Settlement Period. The Claim Administrator 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 Transfer Payments received in the particular Claim Settlement Period 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 Transfer Payment(s) due the Claim Administrator from the Employer. VI1. CLAIMS, AUDITS AND CORRECTION OF ERRORS A. Upon receipt of a Claim, the Claim Administrator will adjudicate the Claim in accordance with the Plan. The Employer retains the right to make final determinations as to the interpretation and � meaning of the provisions of the Plan and the applicability of any such provision in general or in any particular case. However, any reasonable determination by the Claim Administrator in adju- dicating a Claim that a Covered Person is entitled to a benefit shall be conclusive evidence of the liability of the Employer to the Claim Administrator for the Claim Payment pursuant to the above Section entitled "Claim Settlements." B. During the term of this Agreement and within one hundred eighty(180)days after the termination of this 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 made under this Agreement. The audit period may not exceed the two (2) years immediately preceding the commencement date of the particular audit. 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. C. Any errors identified in adjudicating Claims will be promptly corrected by the Claim Administrator subject to the terms and conditions of this Agreement. The Employer will assist and cooperate with the Claim Administrator in recovering errors in payments to or on behalf of Covered Persons but the responsibility for such errors in 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 Claims and shall not be responsible for errors calculated to exist in a population of Claims 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 this Agree- ment. Minor deviations in Claim adjudications from the provisions of this Agreement as a result � of such reasonable administrative practices shall not be considered errors. • I - 4 -