Common use of Consideration of Claim Packages Clause in Contracts

Consideration of Claim Packages. (A) A Claims Administrator shall be selected by BHCP subject to agreement by NPC to review all Claim Packages submitted to the Program and to determine whether a claim is an Eligible Claim entitled to payment under the terms of the Agreement. The Claims Administrator also shall determine the amount, if any, to which the Program Participant is entitled. (B) The Claims Administrator will review each Claim Package. The Claims Administrator shall inform the Program Participant’s counsel, by email, within 90 days (unless the Claims Administrator provides notice that additional time is required) after submission of the Claim Package or, in the case of a Program Participant who fails to submit any Claim Package, within 30 days (unless the Claims Administrator provides notice that additional time is required) after the Claim Package Deadline (each a “Notice”), whether any or all of the Supporting Documentation is missing, inadequate or incomplete. Any Claim Package that cannot, or for any reason does not, include all of the required Supporting Documentation shall be considered incomplete and fails to establish an Eligible Claim, and subjects the Claimant’s case to dismissal with prejudice, as described below, without compensation absent timely cure as set forth herein. The Claims Administrator will review any timely provided materials to address deficiencies within a reasonable period of time after submission of the same and will send an additional notice (each a “Second Notice”) to any Program Participant’s counsel whose Claim Package remains deficient. (C) The decision as to the completeness and adequacy of the Claim Package is in the sole discretion of the Claims Administrator, subject to the terms of Section 5.03(F) below. Failure to correct the deficiencies on or before the later of (x) the thirtieth (30th) day following the date of the Notice or (y) if the Program Participant on or before the thirtieth (30th) day following the date of the Notice has provided to the Claims Administrator a reasonable justification for requiring more than a 30-day cure period (as determined by the Claims Administrator in good faith), the sixtieth (60th) day following the date of the Notice (as applicable, the “Cure Deadline”), will result in automatic rejection of the Claim Package, and the Claims Administrator shall deliver the Release and the Stipulation of Dismissal, if provided, to BHCP, or, if BHCP is not a Defendant in the case, any Defendant in such case. BHCP, or, if BHCP is not a Defendant in the case, any Defendant in such case, may thereupon file the Stipulation of Dismissal with the appropriate court, subject to the resolution of any request for reconsideration or appeal, if permitted by this Agreement. However, BHCP, or, if BHCP is not a Defendant in the case, any Defendant in such case, shall provide a final 10 day notice to the Program Participant's counsel in writing before filing the Stipulation of Dismissal advising that if no action is taken, the Stipulation of Dismissal will be filed. (D) In the event that the Program Participant does not submit a Release or a Stipulation of Dismissal by the Cure Deadline, BHCP, or, if BHCP is not a Defendant in the case, any Defendant in such case, may submit a motion to dismiss the Program Participant’s case with prejudice. Such motions

Consideration of Claim Packages. (A) A Claimant whose Claim Package does not meet the requirements of Section 3.02 shall not be entitled to payment under the terms of this Agreement. (B) The Claims Administrator shall be selected by BHCP subject to agreement by NPC to review all Claim Packages submitted to the Program and to determine whether a claim Claim Package is an Eligible complete and meets the requirements of Section 3.02, and the Claims Administrator’s review of Claim Packages pursuant to this Section shall be limited to determining whether each Claim Package is complete and meets the requirements of Section 3.02. This provision does not limit the Claims Administrator’s authority to review Claim Packages in accordance with the audit provisions set forth in Section 4.06 below. (C) Upon verification by the Claims Administrator that a Claimant has submitted a complete Claim Package, the Claims Administrator shall within ten (10) days provide the Claim Package to the Plaintiff’s Claims Review Committee (also referred to herein as the “PCRC”). A Claimant whose Claim Package does not meet the requirements of Section 3.02 shall not be provided to the PCRC or entitled to consideration of payment under the terms of the this Agreement. The Claims Administrator also shall determine the amount, if any, to which the Program Participant is entitled. (BD) The In the event that the Claims Administrator will review each determines the Claim Package. The Claims Administrator Package is not complete, he or she shall inform the Program Participant’s counsel, if represented, or the Program Participant, if not represented by emailcounsel, within 90 twenty (20) days (unless the Claims Administrator provides notice that additional time is required) after submission of the Claim Package orthat Supporting Documentation is missing, inadequate, or incomplete, or in the case of a Program Participant who fails to submit any Claim Package, within 30 days (unless the Claims Administrator provides notice that additional time is requiredshall within five (5) days after the Claim Package Deadline inform the Program Participant, or if represented by counsel, the Program Participant’s counsel that no Claim Package was received (each a “Notice”), whether any or all of the Supporting Documentation is missing, inadequate or incomplete. Any Claim Package that cannot, or for any reason does not, include all of the required Supporting Documentation shall be considered incomplete and fails incomplete, shall fail to establish an Eligible Claim, and subjects will subject the Claimant’s case Claim to dismissal with prejudice, as described below, without compensation compensation, absent timely cure as set forth herein. The . (E) As part of the Claims Administrator’s determination of the adequacy and completeness of the Claim Package, the Claims Administrator will review any timely provided materials to address deficiencies within determine whether the contemporaneous medical records reflect a reasonable period of time after submission diagnosis of the same and will send an additional notice (each a “Second Notice”) to any Program Participant’s counsel whose Claim Package remains deficient.Alleged Injury after the Program Participant was first prescribed or provided NuvaRing. If the Claims (CF) The decision as to the completeness and adequacy of the Claim Package is in the sole discretion of the Claims Administrator, subject to the terms of reconsideration under Section 5.03(F) below4.03(F). Failure to correct the deficiencies on or before the later of (x) the thirtieth (30th) day following the date of the Notice or (y) if the Program Participant on or before the thirtieth (30th) day following the date of the Notice has provided to the Claims Administrator a reasonable justification for requiring more than a 30-day cure period (as determined by the Claims Administrator in good faith), the sixtieth (60th) day following the date of the Notice (as applicable, the “Cure Deadline”), will result in automatic rejection of the Claim Package. The Claims Administrator shall provide notice of the rejection of the Claim Package to Claimant’s counsel within ten (10) days following the expiration of the Cure Deadline (“Notice of Rejection”). (G) Delivery of Releases and Stipulations of Dismissal to Organon: (1) Following the Claims Administrator’s receipt of a Program Participant’s Stipulation of Dismissal and/or Release pursuant to Section 3.02 above, and the Claims Administrator shall deliver review such documents to determine whether they are complete and valid in form and substance. Organon or its counsel may also review such documents to determine whether they are complete and valid in form and substance. If Organon or the Release and the Stipulation of Dismissal, if provided, Claims Administrator determines that any deficiencies exist as to BHCP, or, if BHCP is not a Defendant in the case, any Defendant in such case. BHCP, or, if BHCP is not a Defendant in the case, any Defendant in such case, may thereupon file the Program Participant’s Stipulation of Dismissal with and/or Release, the appropriate court, subject to Claims Administrator shall follow the resolution notice and cure provisions set forth in Section 3.05(A)-(E) above. Within ten (10) days of any request for reconsideration or appeal, if permitted by this Agreement. However, BHCP, or, if BHCP is not the Claims Administrator’s receipt from a Defendant in the case, any Defendant in such case, shall provide Program Participant of a final 10 day notice to the Program Participant's counsel in writing before filing the Stipulation of Dismissal advising and/or Release that if no action is takenthe Claims Administrator determines to be complete and valid in form and substance, the such Stipulation of Dismissal will and/or Release shall be fileddelivered to Organon by the Claims Administrator. (D2) In the event that the Program Participant does not submit a Release or a Stipulation of Dismissal by the Cure Deadline, BHCP, or, if BHCP is not a Defendant in the case, any Defendant in such case, Organon may submit a motion to dismiss the Program Participant’s case with prejudice. Such motionsmotions shall be made in accordance with Section 5.02. A Claimant may cure a deficiency relating to a Release or Stipulation of Dismissal during the pendency of a motion on a showing of good cause. (H) The Claims Administrator shall provide monthly updates to Organon and NPC as to the submission, review and approval process. Organon or NPC

Consideration of Claim Packages. (A) A Claimant whose Claim Package does not meet the requirements of Section 3.02 shall not be entitled to payment under the terms of this Agreement. (B) The Claims Administrator shall be selected by BHCP subject to agreement by NPC to review all Claim Packages submitted to the Program and to determine whether a claim Claim Package is an Eligible complete and meets the requirements of Section 3.02, and the Claims Administrator’s review of Claim Packages pursuant to this Section shall be limited to determining whether each Claim Package is complete and meets the requirements of Section 3.02. This provision does not limit the Claims Administrator’s authority to review Claim Packages in accordance with the audit provisions set forth in Section 4.06 below. (C) Upon verification by the Claims Administrator that a Claimant has submitted a complete Claim Package, the Claims Administrator shall within ten (10) days provide the Claim Package to the Plaintiff’s Claims Review Committee (also referred to herein as the “PCRC”). A Claimant whose Claim Package does not meet the requirements of Section 3.02 shall not be provided to the PCRC or entitled to consideration of payment under the terms of the this Agreement. The Claims Administrator also shall determine the amount, if any, to which the Program Participant is entitled. (BD) The In the event that the Claims Administrator will review each determines the Claim Package. The Claims Administrator Package is not complete, he or she shall inform the Program Participant’s counsel, if represented, or the Program Participant, if not represented by emailcounsel, within 90 twenty (20) days (unless the Claims Administrator provides notice that additional time is required) after submission of the Claim Package orthat Supporting Documentation is missing, inadequate, or incomplete, or in the case of a Program Participant who fails to submit any Claim Package, within 30 days (unless the Claims Administrator provides notice that additional time is requiredshall within five (5) days after the Claim Package Deadline inform the Program Participant, or if represented by counsel, the Program Participant’s counsel that no Claim Package was received (each a “Notice”), whether any or all of the Supporting Documentation is missing, inadequate or incomplete. Any Claim Package that cannot, or for any reason does not, include all of the required Supporting Documentation shall be considered incomplete and fails incomplete, shall fail to establish an Eligible Claim, and subjects will subject the Claimant’s case Claim to dismissal with prejudice, as described below, without compensation compensation, absent timely cure as set forth herein. The . (E) As part of the Claims Administrator’s determination of the adequacy and completeness of the Claim Package, the Claims Administrator will review any timely provided materials to address deficiencies within determine whether the contemporaneous medical records reflect a reasonable period of time after submission diagnosis of the same and will send an additional notice (each a “Second Notice”) to any Program Participant’s counsel whose Claim Package remains deficient.Alleged Injury after the Program Participant was first prescribed or provided NuvaRing. If the Claims (CF) The decision as to the completeness and adequacy of the Claim Package is in the sole discretion of the Claims Administrator, subject to the terms of reconsideration under Section 5.03(F) below4.03(F). Failure to correct the deficiencies on or before the later of (x) the thirtieth (30th) day following the date of the Notice or (y) if the Program Participant on or before the thirtieth (30th) day following the date of the Notice has provided to the Claims Administrator a reasonable justification for requiring more than a 30-day cure period (as determined by the Claims Administrator in good faith), the sixtieth (60th) day following the date of the Notice (as applicable, the “Cure Deadline”), will result in automatic rejection of the Claim Package. The Claims Administrator shall provide notice of the rejection of the Claim Package to Claimant’s counsel within ten (10) days following the expiration of the Cure Deadline (“Notice of Rejection”). (G) Delivery of Releases and Stipulations of Dismissal to Organon: (1) Following the Claims Administrator’s receipt of a Program Participant’s Stipulation of Dismissal and/or Release pursuant to Section 3.02 above, and the Claims Administrator shall deliver review such documents to determine whether they are complete and valid in form and substance. Organon or its counsel may also review such documents to determine whether they are complete and valid in form and substance. If Organon or the Release and the Stipulation of Dismissal, if provided, Claims Administrator determines that any deficiencies exist as to BHCP, or, if BHCP is not a Defendant in the case, any Defendant in such case. BHCP, or, if BHCP is not a Defendant in the case, any Defendant in such case, may thereupon file the Program Participant’s Stipulation of Dismissal with and/or Release, the appropriate court, subject to Claims Administrator shall follow the resolution notice and cure provisions set forth in Section 3.05(A)-(E) above. Within ten (10) days of any request for reconsideration or appeal, if permitted by this Agreement. However, BHCP, or, if BHCP is not the Claims Administrator’s receipt from a Defendant in the case, any Defendant in such case, shall provide Program Participant of a final 10 day notice to the Program Participant's counsel in writing before filing the Stipulation of Dismissal advising and/or Release that if no action is takenthe Claims Administrator determines to be complete and valid in form and substance, the such Stipulation of Dismissal will and/or Release shall be fileddelivered to Organon by the Claims Administrator. (D2) In the event that the Program Participant does not submit a Release or a Stipulation of Dismissal by the Cure Deadline, BHCP, or, if BHCP is not a Defendant in the case, any Defendant in such case, Xxxxxxx may submit a motion to dismiss the Program Participant’s case with prejudice. Such motionsmotions shall be made in accordance with Section 5.02. A Claimant may cure a deficiency relating to a Release or Stipulation of Dismissal during the pendency of a motion on a showing of good cause. (H) The Claims Administrator shall provide monthly updates to Organon and NPC as to the submission, review and approval process. Organon or NPC