Common use of Plan Benefits Clause in Contracts

Plan Benefits. The Plan Sponsor shall retain the responsibility for all Plan benefit claims and all expenses incident to the Plan. The Plan Sponsor has partially fulfilled such responsibility by its payments made according to this Agreement's Section 4 and the Plan Sponsor's Payment Obligations Attachment. The Plan Sponsor shall also be responsible for: (1) any state premium or similar tax, or any other tax, including assessments from the Affordable Care Act (“ACA”), including any penalties and interest payable with respect thereto, assessed against the Company based on or measured by the amount of Plan benefits administered by the Company according to this Agreement; and (2) subject to Section 7 of this Agreement, any amounts that the Company may become liable for which arise from any legal action or proceeding related to the recovery of benefits under the Plan or the administration of the Plan; and (3) reviewing any claims/benefits payment reports for any readily apparent errors, including but not limited to those related to eligibility, furnished by the Company to the Plan Sponsor and informing the Company of any errors contained therein within thirty (30) days of the Plan Sponsor's receipt of said claim report(s). Failure to notify the Company shall constitute a waiver on the Plan Sponsor's part of any claim against the Company for failure to accurately pay the claim at issue. Any claims errors shall not be an excuse for failing to make payments that are due to the Company; and (4) reimbursing the Company for any Plan benefits paid by the Company to Members who were not eligible for Plan benefits and with respect to whom the Plan Sponsor does not timely notify Company of such Member's lack of eligibility; and (5) reimbursing any health care service provider with whom Company has entered into a provider agreement that has provided covered services to a Member if Company is unable to or otherwise does not reimburse such provider as a result of Plan Sponsor's failure to fulfill its obligations under this Agreement, including but not limited to providing sufficient funds as required under this Agreement. Plan Sponsor further acknowledges that it is responsible and is a guarantor of payment for covered benefits under the Plan. In addition, the Plan Sponsor recognizes that, through provider Agreements negotiated by Company, Plan Sponsor, as the party responsible for payment, has certain obligations not inconsistent with the terms of this Agreement, even though it is not a party to such provider agreements. As such, any Agreement provider may bring a cause of action or assert a lien against Plan Sponsor for payment of any unpaid claims for covered services rendered by such provider to a Member.

Plan Benefits. The Plan Sponsor shall retain the responsibility for all Plan benefit claims and all expenses incident to the Plan. The Plan Sponsor has partially fulfilled such responsibility by its payments made according pursuant to this Agreement's ’s Section 4 and the Plan Sponsor's ’s Payment Obligations Attachment. The Plan Sponsor shall also be responsible for: (1) any state premium or similar tax, or any other tax, including assessments from the Affordable Care Act (“ACA”)Act, including any penalties and interest payable with respect thereto, assessed against the Company based on the basis of or measured by the amount of Plan benefits administered by the Company according pursuant to this Agreement; and (2) subject to Section 7 of this Agreement, any amounts that the Company may become liable for which arise from any legal action or proceeding related to the recovery of benefits under the Plan or the administration of the Plan; and (3) reviewing any and all claims/benefits payment reports for any readily apparent errors, including but not limited to those related to eligibility, furnished by the Company to the Plan Sponsor and informing the Company of any errors contained therein within thirty (30) days of the Plan Sponsor's ’s receipt of said claim report(s). Failure to so notify the Company shall constitute a waiver on the Plan Sponsor's ’s part of any claim against the Company for failure to accurately pay the claim at issueissue accurately. Any claims errors shall not be an excuse for failing to make payments that are due to the Company; and (4) reimbursing the Company for any Plan benefits paid by the Company to Members who were not eligible for Plan benefits and with respect to whom the Plan Sponsor does not timely notify Company of such Member's ’s lack of eligibility; and (5) reimbursing any health care service provider with whom Company has entered into a provider agreement that has provided covered services to a Member if Company is unable to or otherwise does not reimburse such provider as a result of Plan Sponsor's ’s failure to fulfill its obligations under this Agreement, including but not limited to providing sufficient funds as required under this Agreement. Plan Sponsor further acknowledges that it is responsible and is a guarantor of payment for covered benefits under the Plan. In addition, the Plan Sponsor recognizes acknowledges that, through provider Agreements negotiated by Company, Plan Sponsor, as the party responsible for payment, has certain obligations not inconsistent with the terms of this Agreement, even though it is not a party to such provider agreements. As such, any Agreement provider may bring a cause of action or assert a lien against Plan Sponsor for payment of any unpaid claims for covered services rendered by such provider to a Member.

Plan Benefits. The Plan Sponsor shall retain the responsibility Client is solely responsible for all Plan benefit claims and all expenses incident to the PlanPlan and no payment of Plan benefits by Company shall be construed as an assumption of any of Client’s liability for such Plan benefits. The Plan Sponsor has partially fulfilled such responsibility by its payments made according to this Agreement's Section 4 and the Plan Sponsor's Payment Obligations Attachment. The Plan Sponsor Client shall also be responsible for: (1) any state premium or similar tax, or any other tax, including assessments from the Affordable Care Act (“ACA”)however denominated, including any penalties and interest payable with respect thereto, assessed against the Company based on or the basis of and/or measured by the amount of Plan benefits administered by the Company according pursuant to this AgreementContract; and (2) the consequence to any person not a Party to this Contract of any acts or omissions of Client occurring during the operation of this Contract that are alleged to be a breach of fiduciary duty or a breach of duty or trust, or other contractual duty, regardless of the source of law serving as a basis for such allegation; and (3) subject to Section 7 of this AgreementContract, any amounts that the Company may become liable for which arise from any legal action or proceeding related to the recovery of benefits under the Plan or the administration of the Plan; and (34) reviewing any and all claims/benefits payment reports for any readily apparent errors, including but not limited to those related to eligibility, furnished by the Company to the Plan Sponsor Client and informing the Company of any errors contained therein within thirty (30) days of the Plan SponsorClient's receipt of said claim report(s). Failure to so notify the Company shall constitute a waiver on the Plan SponsorClient's part of any claim against the Company for failure to accurately pay the claim at issue. Any claims errors shall not be an excuse for failing to make payments that are due to the Company; and (45) reimbursing the Company for any Plan benefits paid by the Company to Members who were not eligible for Plan benefits and with respect to whom the Plan Sponsor Client does not timely notify Company of such Member's ’s lack of eligibility; and (56) reimbursing any health care service provider with whom Company has entered into a provider agreement that has provided covered services to a Member if Company is unable to or otherwise does not reimburse such provider as a result of Plan Sponsor's Client’s failure to fulfill its obligations under this AgreementContract, including but not limited to providing sufficient funds as required under this Agreementfunding the Benefits Plan Account for payment of claims. Plan Sponsor Client further acknowledges that it is responsible responsible, and is a guarantor of payment payment, for covered benefits under the Plan. In addition, the Plan Sponsor recognizes Client acknowledges that, through provider Agreements contracts negotiated by Company, Plan SponsorClient, as the party responsible for payment, has certain obligations not inconsistent with the terms of this AgreementContract, even though it is not a party to such provider agreements. As such, any Agreement contracted provider may bring a cause of action or assert a lien against Plan Sponsor Client for payment of any unpaid claims for covered services rendered by such provider to a Member; and (7) reimbursing the external review expenses described in Section 2. (8) reimbursing Company for any Plan benefits it may be required to pay as a result of any legal action.

Plan Benefits. The Plan Sponsor shall retain the Client is solely responsibility for all Plan benefit claims and all expenses incident to the PlanPlan and no payment of Plan benefits by Company shall be construed as an assumption of any of Client’s liability for such Plan benefits. The Plan Sponsor Client has partially fulfilled such responsibility by its payments made according pursuant to this Agreement's Contract’s Section 4 and the Plan Sponsor's Client’s Payment Obligations AttachmentAppendix. The Plan Sponsor Client shall also be responsible for: (1) any state premium or similar tax, or any other tax, including assessments from the Affordable Care Act (“ACA”)however denominated, including any penalties and interest payable with respect thereto, assessed against the Company based on or the basis of and/or measured by the amount of Plan benefits administered by the Company according pursuant to this AgreementContract; and (2) the consequence to any person not a Party to this Contract of any acts or omissions of Client occurring during the operation of this Contract that are alleged to be a breach of fiduciary duty or a breach of duty or trust, or other contractual duty, regardless of the source of law serving as a basis for such allegation; and (3) subject to Section 7 of this AgreementContract, any amounts that the Company may become liable for which arise from any legal action or proceeding related to the recovery of benefits under the Plan or the administration of the Plan; and (34) reviewing any and all claims/benefits payment reports for any readily apparent errors, including but not limited to those related to eligibility, furnished by the Company to the Plan Sponsor Client and informing the Company of any errors contained therein within thirty (30) days of the Plan SponsorClient's receipt of said claim report(s). Failure to so notify the Company shall constitute a waiver on the Plan SponsorClient's part of any claim against the Company for failure to accurately pay the claim at issue. Any claims errors shall not be an excuse for failing to make payments that are due to the Company; and (45) reimbursing the Company for any Plan benefits paid by the Company to Members who were not eligible for Plan benefits and with respect to whom the Plan Sponsor Client does not timely notify Company of such Member's ’s lack of eligibility; and (56) reimbursing any health care service provider with whom Company has entered into a provider agreement that has provided covered services to a Member if Company is unable to or otherwise does not reimburse such provider as a result of Plan Sponsor's Client’s failure to fulfill its obligations under this AgreementContract, including but not limited to providing sufficient funds in the Transfer Account as required under this AgreementSection 3. Plan Sponsor Client further acknowledges that it is responsible responsible, and is a guarantor of payment payment, for covered benefits under the Plan. In addition, the Plan Sponsor recognizes Client acknowledges that, through provider Agreements contracts negotiated by Company, Plan SponsorClient, as the party responsible for payment, has certain obligations not inconsistent with the terms of this AgreementContract, even though it is not a party to such provider agreements. As such, any Agreement contracted provider may bring a cause of action or assert a lien against Plan Sponsor Client for payment of any unpaid claims for covered services rendered by such provider to a Member; and (7) reimbursing the external review expenses described in Section 2. (8) reimbursing Company for any Plan benefits it may be required to pay as a result of any legal action.

Plan Benefits. The Plan Sponsor shall retain the Client is solely responsibility for all Plan benefit claims and all expenses incident to the PlanPlan and no payment of benefits by Company shall be construed as an assumption of any of Client’s liability for such Plan benefits. The Plan Sponsor Client has partially fulfilled such responsibility by its payments made according pursuant to this Agreement's Contract’s Section 4 and the Plan Sponsor's Client’s Payment Obligations AttachmentAppendix. The Plan Sponsor Client shall also be responsible for: (1) any state premium or similar tax, or any other tax, including assessments from the Affordable Care Act (“ACA”)however denominated, including any penalties and interest payable with respect thereto, assessed against the Company based on or the basis of and/or measured by the amount of Plan benefits administered by the Company according pursuant to this AgreementContract; and (2) the consequence to any person not a Party to this Contract of any acts or omissions of Client occurring during the operation of this Contract that are alleged to be a breach of fiduciary duty or a breach of duty or trust, or other contractual duty, regardless of the source of law serving as a basis for such allegation; and (3) subject to Section 7 of this AgreementContract, any amounts that the Company may become liable for which arise from any legal action or proceeding related to the recovery of benefits under the Plan or the administration of the Plan; and (34) reviewing any and all claims/benefits payment reports for any readily apparent errors, including but not limited to those related to eligibility, furnished by the Company to the Plan Sponsor Client and informing the Company of any errors contained therein within thirty (30) days of the Plan SponsorClient's receipt of said claim report(s). Failure to so notify the Company shall constitute a waiver on the Plan SponsorClient's part of any claim against the Company for failure to accurately pay the claim at issue. Any claims errors shall not be an excuse for failing to make payments that are due to the Company; and (45) reimbursing the Company for any Plan benefits paid by the Company to Members who were not eligible for Plan benefits and with respect to whom the Plan Sponsor Client does not timely notify Company of such Member's ’s lack of eligibility; and (56) reimbursing any health vision care service provider with whom Company has entered into a provider agreement that has provided covered services to a Member if Company is unable to or otherwise does not reimburse such provider as a result of Plan Sponsor's Client’s failure to fulfill its obligations under this AgreementContract, including but not limited to providing sufficient funds in the Transfer Account as required under this AgreementSection 3. Plan Sponsor Client further acknowledges that it is responsible responsible, and is a guarantor of payment payment, for covered benefits under the Plan. In addition, the Plan Sponsor recognizes Client acknowledges that, through provider Agreements contracts negotiated by Company, Plan SponsorClient, as the party responsible for payment, has certain obligations not inconsistent with the terms of this AgreementContract, even though it is not a party to such provider agreements. As such, any Agreement contracted provider may bring a cause of action or assert a lien against Plan Sponsor Client for payment of any unpaid claims for covered services rendered by such provider to a Member; and (7) reimbursing Company for any Plan benefits it may be required to pay as a result of any legal action. (8) reimbursing the external review expenses described in Section 2.