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© Peak One Administration 2016 31 <br />Client will calculate and notify PSP at least ninety (90) days prior to the date a retiree or other <br />Qualified Beneficiary will become eligible for Medicare. <br />3. Provider/Carrier Response: PSP will provide responses to inquiries by providers and/or insurance <br />carriers regarding coverage status of retirees and Qualified Beneficiaries. All responses will be <br />based solely on the current information maintained by PSP as provided by Client. <br />4. Transfer of Data: PSP will establish a standard procedure for exchanging information. <br /> <br />Client, at least two (2) weeks prior to commencement of services under this Agreement, Client will <br />submit to PSP the following information: <br />(a) Complete roster of all employees who are active participants in the Health Plans. This <br />information may be submitted on forms provided by PSP, from computer records that <br />contain the same information requested on forms provided by PSP, or by providing copies <br />of all Health Plan enrollment forms. <br />(b) A completed and signed questionnaire regarding the Health Plan under which retiree <br />alternative coverage is offered by Client. <br />(c) A completed data sheet (provided by PSP) for each of the following: (i) retirees currently <br />maintaining coverage in the Health Plan under retiree self-pay alternative coverage, () <br />Qualified Beneficiaries who have been notified and are in the COBRA election period; and <br />(c) Qualified Beneficiaries who have not been notified of the option to elect retiree self- <br />pay coverage in lieu of COBRA. <br />The responsibilities of PSP for retiree coverage premium billing are limited to those stated in this <br />Appendix. The Client is solely responsible for all other aspects of retiree coverage under the Health <br />Plan including, but not limited to, determining who is eligible for retiree self-pay coverage as <br />alternative coverage to COBRA, obtaining and determining the sufficiency of all necessary COBRA <br />waivers and elections for alternative coverage in the form of retiree self-pay coverage from each <br />retiree and his/her Qualified Beneficiaries, determining the effectiveness of any such waivers and <br />elections under applicable Federal and state continuation of group health plan coverage laws, <br />maintaining the necessary plan documents, coordinating retiree coverage with insurance carriers, <br />including any stop loss carrier, preparing and submitting all applicable governmental reporting, <br />calculating and remitting all applicable taxes and fees imposed by state and/or Federal <br />governmental agencies. <br />Client may engage PSP to perform the services delineated below upon terms mutually agreed upon <br />by Client and PSP in writing. <br /> <br />Optional Services <br />These are provided only upon request of the Client. <br />Optional <br />Fees <br />1. Benefit Plan consulting, including but not limited to, discussions regarding <br />Benefit Plan design, compliance and communications. <br />Quote <br />2. Requested changes to any standard administrative procedures established by <br />PSP. <br />Quote <br />3. Exchanging information by means other than the standard procedure <br />established by PSP (as set forth above). PSP will provide Client with several <br />options for transferring data, including diskette, model file transfer or if the <br />foregoing transfer methods are not available for the Client’s payroll system, <br />in a mutually acceptable format. <br />Quote