Common use of Delegation of Responsibility Clause in Contracts

Delegation of Responsibility. 6.8.1 It is understood and agreed that SHP is neither the "plan administrator" or the "plan sponsor" of the group's health benefit programs as described under applicable law, including under ERISA, and that the Group retains complete authority and responsibility for such group health programs. SHP is empowered to act on behalf of the Group only to the extent expressly stated in the Contract or as agreed to in writing by the Group and SHP. 6.8.2 The Group and SHP agree that with respect to XXXXX, SHP will be the "appropriate named fiduciary" of the Plan solely for the purpose of reviewing claims and the appeals of any denied claims under the Plan. In exercising this responsibility, SHP shall have the discretionary authority to determine entitlement to Plan benefits as determined by the Member Certificate and other governing documents for each claim received, and to construe the terms of the Member Certificate and other documents. 6.8.3 The Group has the sole and complete authority to determine eligibility of persons to participate in the Plan. 6.8.4 SHP has no other fiduciary responsibilities with respect to the Group or the Plan.

Appears in 2 contracts

Samples: Master Small Group Policy, Master Large Group Policy

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Delegation of Responsibility. 6.8.1 19.1. It is understood and agreed that SHP is neither the "plan administrator" or the "plan sponsor" of the group's Group’s health benefit programs as described under applicable law, including under ERISA, and that the Group retains complete authority and responsibility for such group health programs. SHP is empowered to act on behalf of the Group only to the extent expressly stated in the Contract or as agreed to in writing by the Group and SHP. 6.8.2 19.2. The Group and SHP agree that with respect to XXXXXERISA, SHP will be the "appropriate named fiduciary" of the Plan solely for the purpose of reviewing claims and the appeals of any denied claims under the Plan. In exercising this responsibility, SHP shall have the discretionary authority to determine entitlement to Plan benefits as determined by the Member Certificate and other governing documents for each claim received, and to construe the terms of the Member Certificate and other documents. 6.8.3 19.3. The Group has the sole and complete authority to determine eligibility of persons to participate in the Plan. 6.8.4 19.4. SHP has no other fiduciary responsibilities with respect to the Group or the Plan.

Appears in 2 contracts

Samples: Master Large Group Policy Application Addendum, Master Large Group Policy

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