Claims Administrator’s Duties. The Claims Administrator shall (1) mail the Notice of Class Action Settlement (the “Notice”) and Claim Forms to Proposed Settlement Class Members;
Claims Administrator’s Duties. 8.1 The Claims Administrator shall (1) mail the Notice of Class Action Settlement (the “Notice”) and Claim Forms to Proposed Class Members; (2) receive Claim Forms and forward them to the Independent Claim Expert to evaluate claims and determine awards; (3) seek additional information from Claimants or Lead Class Counsel, when appropriate; (4) respond to questions from Proposed Class Members; (5) receive awards information from the Independent Claim Expert and distribute awards to Proposed Class Members; (6) maintain a toll-free number for communicating with Proposed Class Members; (7) mail checks to Proposed Class Members and Class Counsel; and (8) any other duties necessary to carry out its responsibilities described in this Agreement,
Claims Administrator’s Duties. The Claims Administrator will furnish appropriate application forms and related material and will provide such assistance as may be reasonably necessary for the Employer to enroll its employees, former employees, and their eligible dependents in the Plan. The Claims Administrator will maintain up-to-date eligibility status records on all enrolled Members as submitted by the Employer. The Claims Administrator will issue identification cards to each Member who is enrolled in the Plan and who is certified as eligible by the Employer.
Claims Administrator’s Duties. The Employer requests the Claims Administrator to prepare a benefit booklet that will serve as a summary plan description (SPD) or summary of material modifications (SMM). Pending finalization of the benefit booklet, the Employer directs the Claims Administrator to process benefits and terms under the plan in accordance with the provisions of the Group Enrollment or Implementation Agreement, this Agreement, the standard benefit language maintained by the Claims Administrator for the type of plan established by the Employer herein, and any draft benefit booklets treated as “operative” by the Claims Administrator. A draft benefit booklet shall be considered operative by the Claims Administrator when the booklet serves as the primary, but not the sole, instrument upon which the Claims Administrator bases its administration of the Plan, without regard to whether the booklet is finalized or distributed to the Plan’s participants. If there is any conflict between any of the foregoing documents, the Claims Administrator is directed to resolve such conflict in a manner that best effectuates the intent of the Employer and the Claims Administrator as of the date on which claims were incurred.
Claims Administrator’s Duties. The Claims Administrator will send to the Employer such information that the Claims Administrator has within its possession as will permit the Employer to prepare, file, and/or distribute reports for the Plan required by law or regulation.
Claims Administrator’s Duties. The Claims Administrator will exercise the discretionary authority to process and adjudicate claims under the Plan. This authority encompasses all determinations and findings necessary to process and adjudicate claims, such as the discretionary authority to construe and apply the Plan, make findings of fact, and determine whether services or supplies are medically necessary (within the meaning of the Plan) or otherwise satisfy the medical standards or guidelines required for payment of benefits under the Plan (such as, for example, the requirement that medical services or supplies not be experimental or investigational). The Claims Administrator will include a description of its claims procedures in the draft benefit booklet prepared by the Claims Administrator in accordance with Section C above. The Employer will be responsible for making all eligibility determinations under the Plan. It is the Employer’s intent that the Claims Administrator’s determination be given the highest level of deference and finality permitted under applicable law.
Claims Administrator’s Duties. The Claims Administrator will exercise the discretionary authority to review denied claims and if applicable, follow the requirements under the Affordable Care Act. The Claims Administrator will be responsible for providing the Member with a full and fair review of his or her denied claim. The Claims Administrator will include a description of its appeal procedures in the draft benefit booklet prepared by the Claims Administrator in accordance with Section C above. It is the Employer’s intent that the Claims Administrator’s determination be given the highest level of deference and finality permitted under applicable law. It shall be the responsibility and duty of the Employer to comply with any applicable notice provisions, appeal provisions and other provisions of the Affordable Care Act related to Employer’s initial Member eligibility determinations and retroactive cancellations.
Claims Administrator’s Duties. The Claims Administrator will function as a business associate of the Plan in accordance with the privacy and security regulations issued by the Secretary of Health and Human Services under HIPAA. The Claims Administrator will sign a separate business associate agreement with the Plan. In the event of any conflict between this Agreement and the Business Associate Agreement, the Business Associate Agreement shall control.
Claims Administrator’s Duties. The Claims Administrator will enroll a child as directed by the Employer pursuant to the terms of a National Medical Support Notice (NMSN).
Claims Administrator’s Duties. Upon written request, the Claims Administrator will provide stop-loss reports to the Employer on adjudicated claims.
