Terms of Insurance Policies to Govern. The extent of coverage under the insurance policies (including self-insured plans) referred to in this Agreement shall be governed by the terms and conditions set forth in said policies or plans. Any questions or disputes concerning an employee's claim for benefits under said insurance policies or plans shall be resolved in accordance with the terms and conditions set forth in said policies or plans, including the claims appeal process available through the insurance company or third party administrator, and shall not be subject to the grievance procedure set forth in this Agreement unless in the context of a self-insured plan, the City either (1) assumes the role of directly administering the terms of the plan without a third-party administrator or (2) overrides the decision of the City's third-party administrator inconsistent with the terms of the plan regarding specific claims for coverage. The failure of any insurance carrier(s) or plan administrator(s) to provide any benefit for which it has contracted or is obligated shall result in no liability to the City, nor shall such failure be considered a breach by the City of any obligation undertaken under this or any other Agreement. However, nothing in this Agreement shall be construed to relieve any insurance carrier(s) or plan administrator(s) from any liability it may have to the City, employee or beneficiary of any employee.
Appears in 15 contracts
Samples: Collective Bargaining Agreement, Collective Bargaining Agreement, Collective Bargaining Agreement
