Enrollment and Determination of Eligibility. (1) The Client shall: (a) handle all routine inquiries from Members, including inquiries from Members seeking information concerning enrollment in the Plan and information concerning particular aspects of the Plan; and (b) handle all enrollment activity; and (c) notify Members of their right to apply for benefits and make available the necessary enrollment, claim and any other necessary forms supplied by the Company; and (2) In determining any person's right to benefits under the Plan, the Company shall rely on eligibility information consistent with the description in the Plan and information provided by the Client. It is mutually understood that the effective performance of this Contract by the Company will require that it be advised on a timely basis by the Client of the identity of persons covered under the Plan, and the effective date or the termination date of their coverage. For the purpose of determining fees under this Contract, a Member shall be considered to be: (a) enrolled on the date of enrollment if the enrollment date is the first date of the month; (b) enrolled on the first day of the first month following the month in which the Member is eligible to receive benefits under the Plan where the enrollment is after the first of the month; and (c) terminated on the last day of the last month in which the Member is eligible to receive benefits under the Plan. Retroactive adjustments for Member enrollment or termination may be allowed for periods not exceeding sixty (60) days. Client shall remain liable to Company for any claims that were paid on the Plan’s behalf for services rendered to a Member after the date on which Client seeks to terminate said Member but prior to Company’s notification of such retroactive termination.
Appears in 3 contracts
Samples: Administrative Services Contract, Administrative Services Contract, Administrative Services Contract
Enrollment and Determination of Eligibility. (1) The Client Plan Sponsor shall:
(a) handle all routine inquiries from Members, including inquiries from Members seeking information concerning enrollment in the Plan and information concerning particular aspects of the Plan; and
(b) handle all enrollment activity; and
(c) notify Members of their right to apply for benefits and make available the necessary enrollment, claim claim, and any other necessary forms supplied by the Company; and
(2) In determining any person's ’s right to benefits under the Plan, the Company shall rely on eligibility information consistent with the description in the Plan and information provided by the ClientPlan Sponsor. It is mutually understood that the effective performance of this Contract Agreement by the Company will require that it be advised on a timely basis by the Client Plan Sponsor of the identity of persons covered under the Plan, Plan and the effective date or the termination date of their coverage. For the purpose of determining fees under this ContractAgreement, a Member shall be considered to be:
(a) enrolled on the date of enrollment if the enrollment date is the first date of the month;
(b) enrolled on the first day of the first month following the month in which the Member is eligible to receive benefits under the Plan where the enrollment is after the first of the month; and
(c) terminated on the last day of the last month in which the Member is eligible to receive benefits under the Plan. Retroactive adjustments for Member enrollment or termination may be allowed for periods not exceeding sixty (60) days. Client Plan Sponsor shall remain liable to Company for any claims that were paid on the Plan’s behalf for services rendered to a Member after the date on which Client Plan Sponsor seeks to terminate said Member but prior to Company’s notification of such retroactive termination.
Appears in 2 contracts
Samples: Administrative Services Agreement, Stop Loss Application; Policy; And Administrative Services Agreement
Enrollment and Determination of Eligibility. (1) The Client shall:
(a) handle all routine inquiries from Members, including inquiries from Members seeking information concerning enrollment in the Plan and information concerning particular aspects of the Plan; and
(b) handle all enrollment activity; and
(c) notify Members of their right to apply for benefits and make available the necessary enrollment, claim and any other necessary forms supplied by the Company; and
(2) In determining any person's right to benefits under the Plan, the Company shall rely on eligibility information consistent with the description in the Plan and information provided by the Client. It is mutually understood that the effective performance of this Contract by the Company will require that it be advised on a timely basis by the Client of the identity of persons covered under the Plan, and the effective date or the termination date of their coverage. For the purpose of determining fees under this Contract, a Member shall be considered to be:
(a) enrolled on the date of enrollment if the enrollment date is the first date of the month;
(b) enrolled on the first day of the first month following the month in which the Member is eligible to receive benefits under the Plan where the enrollment is after the first of the month; and
(c) terminated on the last day of the last month in which the Member is eligible to receive benefits under the Plan. Retroactive adjustments for Member enrollment or termination may be allowed for periods not exceeding sixty (60) days. Client shall remain liable to Company for any claims that were paid on the Plan’s behalf for services rendered to a Member after the date on which Client seeks to terminate said Member but prior to Company’s notification of such retroactive termination.
Appears in 1 contract
Samples: Administrative Services Contract
