R89-148 AUTHORIZING APPLICATIONS FOR GROUP HEALTH INSURANCE COVERAGES

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. � 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 . VII . 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 meaninq of the provisions of the Plan and the applicability of any such provision in general or in any particular cas� . However, any reasonable determination by the Claim Administrator in adjudicating 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 eiqhty ( 180 ) days after the termination of this Agree- ment, 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 C1aim 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 Administra- tor' 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 pay- ments 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 correc- tion 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 prac- tices in the administration of this provision. Minor -6-