Referral of Certain Claims/Inquiries. As provided in this Agreement, HEBP will receive eligibility information, review and process claims, and respond to customer inquiries; however, HEBP does not have final authority to determine Participants’ eligibility or to establish or construe the terms and conditions of Member’s Plan. Therefore, in certain instances, HEBP may refer certain claims to the Plan Administrator for review and final decision, particularly when those claims for services do not appear to qualify for payment under Member’s Plan, claims or inquiries where there is a question of eligibility, claims where there is a question as to the amount of payment due, and claims involving litigation or the threat of litigation. Such referral shall be at the sole discretion of HEBP.
Appears in 7 contracts
Samples: Administrative Services Agreement, Administrative Services Agreement, Administrative Services Agreement
