2023/11/29 Council Agenda Packet

© Peak One Administration 2016 16 7. Claims Adjudication. PSP will have no discretionary authority to interpret the terms of a Benefit Plan or adjudicate claims. If processing a benefit claim requires interpretation of ambiguous plan language, and Client has not previously indicated to PSP the proper interpretation of the language, then Client will be responsible for resolving the ambiguity or any other dispute. PSP will make the initial determination on the first (1st) level of appeal (if a Benefit Plan has two (2) levels of appeal), regarding a claim for benefits under a Benefit Plan. 8. Benefit Payment Disbursements. PSP will disburse benefit payments that are determined to be payable in accordance with the terms of the applicable Benefit Plan as soon as reasonably possible after such determination is made, provided that sufficient funds have been made available by the Client (as set forth below) to pay such benefit payments. If sufficient funds have not been made available, PSP will notify Client that sufficient funds have not been made available. If sufficient funds have not been made available within thirty (30) days of the date that PSP has notified Client of the insufficiency, PSP in addition to its rights under the Agreement may, without risk of violating the Agreement or this Service Appendix, notify the affected participants that the Client has not made the funds available necessary to pay his or her claim. 9. Standard Reports. PSP will provide the Client its standard, written, semi-monthly reports summarizing the reimbursement account activities from the previous period, including a claims history report for all claims processed. PSP will provide electronically to Client, the following standard reports: standard reports for payroll setup of employee elections including employee deductions report; employee contribution report and Employee contribution spreadsheet; employee confirmation letters to verify elections when required; statements of participation by plan and participant as requested; annual reports of claim history and budget analysis reports; status and history reports such as account balance totals on each reimbursement check; account balances report on the Employee Account Status letter on a monthly basis during the final quarter of the plan year and account history reports and check history reports. PSP will also provide its standard initial administrative form originals for duplication as needed: reimbursement claim forms; participant instructions for filing claim forms; election enrollment; termination; and change of election forms. On a pay cycle basis, PSP will provide its following standard: Contribution Billing Report or electronic contribution file to be used to reconcile with payroll deduction amounts; reimbursement checks and/or direct deposits to employees on a pay cycle basis or on an approved schedule upon receipt of expense receipts and approved claim vouchers; and on-line Payment Registers. On a monthly basis, PSP will provide its standard following reports on an as needed basis: Cash Status Report; Request for Funds Report; and on- line Employee Account Balances. On an annual basis, PSP will provide: Employee Account Balance Report; and Plan Forfeitures and Account Close-Out reports. Also, if a separate Reimbursement Card Services Appendix is attached hereto, PSP will make available to covered individuals, use of an electronic payment card through which eligible medical and/or dependent care expenses may be paid. The terms of usage of such electronic payment card and the rights and responsibilities of PSP and the Client with respect to such card will be set forth in a separate Appendix incorporated hereto by reference. PSP reserves the right to modify its standard reports. 10. Transfer of Data. PSP will establish a standard procedure for exchanging information.