R95-141 AUTHORIZING APPLICATIONS FOR GROUP HEALTH INSURANCE COVERAGE

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� an undetermined but substantial number of Claims for services rendered or furnished prior to that date which have not been submitted to the Claim Administrator for reimbursement and also an undetermined but substantial number of Claims submitted for reimbursement which have not been paid by the Claim Administrator. The Employer shall be responsible for the payment of all Claim Payments for services rendered or furnished to a Covered Person prior to the date of ter- mination, whether or not Claims for such services have been submitted, or Claim Payments for such services have been made by the Claim Administrator, as of the date of termination, and for the payment of the service charge(s) in effect on the date of termination. Further, if a Covered Person is an Inpatient at the time his coverage under the Plan terminates, the Plan shall provide benefits for Covered Services which are provided by and regularly charged for by a Hospital or other facility Provider until the Covered Person is discharged or until the end of the Covered Per- son's benefit period, whichever occurs first ("Extended Benefits"). The Employer shall be liable to the Claim Administrator for all Claim Payments and the applicable service charges for such Extended Benefits. C. In consideration of Claim Administrator's continuing to make Claim Payments in accordance with the Section above entitled"Claims, Audits and Correction of Errors,"the Employer shall continue to make the Transfer Payments referred to in Section V. above for a three (3) month period after the effective date of termination. D. The Claim Administrator will continue to make Claim Payments for a six (6) month period follow- ing the effective date of termination. This period shall be referred to as the"Tentative Final Settle- ment Period." A"Final Claim SettlemenY'shall be made within sixty (60) days after the last day of the Tentative Final Settlement Period. This Final Claim Settlement shall compare the Transfer Payments against the Claim Settlement Total for the Tentative Final Settlement Period. The dif- � ference shall be paid or applied as set forth in Section VI. paragraphs B. and C. of the Section above entitled"Claim Settlements." However, if the Transfer Payments exceed the Claim Settle- ment Total for the Tentative Final Settlement Period,the Claim Administrator shall pay such differ- ence to the Employer after applying the difference against amounts, if any, then owed to the Claim Administrator by the Employer. E. The Employer further acknowledges that the Claim Administrator may make Claim Payments af- ter the Tentative Final Settlement is computed for services rendered or furnished prior to the ter- mination date or as otherwise specified in Section IX. paragraph B. above. The Claim Adminis- trator will bill the Employer periodically, but not more frequently than monthly,for the total of those Claim Payments and the service charge(s) in effect on the date of termination. All sums due the Claim Administrator will be paid in full by the Employer no later than ten (10) days after receipt of the Claim Administrator's invoice for such payment. X. RELATIONSHIP OF PARTIES A. The Claim Administrator is an independent contractor with respect to the Employer, and nothing in this Agreement shall create, or be construed to create, the relationship of Employer and em- ployee between the Claim Administrator and the Employer, nor shall the Employer's agents, offi- cers or employees be considered or construed to be considered employees of the Claim Admin- istrator for any purpose whatsoever. B. It is understood and agreed that nothing contained in this Agreement shall confer or be construed to confer any benefit on persons who are not parties to this Agreement including, but not limited to, employees of the Employer and their dependents. � C. Section XVI. below entitled"ERISA"contains further information regarding the relationship of the parties hereto. - 6 -