2023/11/29 Council Agenda Packet

© Peak One Administration 2016 18 5. Eligibility Determination & Information. Client will maintain current and accurate Benefit Plan eligibility and coverage records, determine and verify the individuals who satisfy eligibility requirements and provide current eligibility files to PSP in a format and at intervals acceptable to PSP. Client will notify PSP in writing of changes in eligibility (e.g., addition, termination, retirement, change in family status, expiration of QMSCO, etc.) at least five (5) business days prior to the first billing cycle for which any such eligibility change is effective. Client is solely responsible for matters pertaining to Client’s failure to provide PSP accurate or timely eligibility information. PSP will have no responsibility for billing or coverage errors related to Client’s failure to provide PSP timely or accurate information. 6. Authorization to Access Medical Records. Client will, if required by law, notify each individual benefiting under the applicable Benefit Plan and provide each individual with an opportunity to opt out (if required), or obtain from each individual, an adequate authorization for release of any personal financial records and medical records in accordance with applicable state and federal laws to permit the PSP to perform its obligations under this Agreement. 7. Regulatory Compliance. Client will: (a) ensure that the Benefit Plans, in design and operation, comply with all applicable laws and regulations, including, but not limited to, the Patient Protection and Affordable Care Act (“PPACA”), Code, ERISA, COBRA, FMLA, and HIPAA; (b) perform all nondiscrimination testing other than the testing specifically delegated to PSP in the attached Appendices; (c) take appropriate action to ensure the ongoing compliance of the Benefit Plan documents with applicable law; (d) file any required report or return with the applicable governmental agency; (e) calculate and pay any governmental or regulatory charges, assessments, fees and/or taxes due or payable by the Client or the Benefit Plans with respect to the establishment or operation of the Benefit Plans; (f) maintain the records of the Benefit Plans and (g) respond to any state or federal governmental agency request for information or audit. 8. Named Fiduciary and Plan Administrator. To the extent that a Benefit Plan is subject to ERISA, Client is the Named Fiduciary and Plan Administrator with respect to the Benefit Plan(s) as those terms are defined in Section(s) 3(16)(A) and 402(a)(1) ERISA. 9. Verification of Information Provided by PSP. Client will verify information provided by PSP, including the Administrative Contribution Billing Reports, provided by PSP to ensure that the information accurately reflects the activity recorded in the Client’s payroll and reconciling the payroll deductions amounts paid with pre-tax dollars with the Administrative Contribution Billing Reports provided for that purpose each pay cycle by PSP. 10. Claims Adjudication. PSP will refer to Client or its designee for final determination, any claim for benefits or coverage appealed after initial denial by PSP, or any class of claims specified in writing by the Client. Client will be responsible for the final appeal determination as to whether a claim is payable under the terms of the Benefit Plans. Client will resolve all ambiguities and disputes relating to the eligibility, benefits, denial of claims or decisions regarding appeal or denial of claims, or any other plan document interpretation issues. 11. Funding and Liability for Claims and Benefit Plan Expenses. Client is responsible for payment of benefits under the Benefit Plans and Benefit Plan Expenses, including but not limited to, all benefits to participants in accordance with the plan document. Client will promptly make sufficient funds available to PSP for payment of benefits due for claims of individuals benefiting under the Benefit Plan. PSP will not advance its own funds if the Client does not provide sufficient funds for payment of claims. Client will also be responsible for payment of any costs or fees assessed to PSP associated with insufficient funding of claims.