Healthcare Management Administrators (HMA) 2/20/2025

HMA TPA Agreement Page 3 4/22 SPD will be the responsibility of the Plan Administrator. The preparation of any Summaries of Material Modifications, along with the distribution of the SPD and any amendments is the responsibility of the Plan Administrator. Document translation support and printing/distribution fulfillment support is available upon request for additional fees that will be quoted at the time requested. HMA shall assist the Plan Administrator in communicating to Participants any and all subsequent changes to the Plan approved by Plan Sponsor. (b)Open Enrollment Materials Services. Upon request HMA shall prepare and assist the Plan Administrator in distributing benefit booklets to the Plan Participants. Initial booklet supply is not included as a part of the Plan set-up fee. Subsequent supplies are also at the Plan Sponsor’s cost. (c)Claims Processing Services. Subject to the provisions of Section 2, HMA agrees to provide the following claims processing and payment processing services, including, but not limited to: (i)Answer telephone inquiries from employees of Plan Sponsor regarding eligibility and coverage under the Plan and respond to requests for forms and status inquiries on filed claims and benefit payments. HMA will provide adequate customer service representatives between the hours of 6:00 a.m. to 6:00 p.m. PST, Monday thru Friday, during non-holiday workweeks. (ii)Receive and process claims for payment of covered benefits for Plan Participants in accordance with the provisions of the Plan, for claims incurred on and after the Effective Date of this Agreement. (iii)Communicate with Plan Participants and health care providers as necessary to obtain additional information deemed necessary to process benefit claims. (iv)Request and obtain from the Plan Administrator, as necessary, interpretations with respect to the provisions of the Plan and other guidance as necessary for adjudication of claims. (v)Issue and distribute claims payments to providers and/or Participants, from funds provided by the Plan Sponsor, and provide appropriate Explanation of Benefit forms (“EOB’s”) to Plan Participants and health care providers, as applicable. (vi) Provide appropriate written notice to a Plan Participant and the provider of claim denial and the opportunity for review of the denial. (vii)Provide Plan Administrator with information and supporting documentation associated with a member initiated second level appeal to allow the Plan to render a determination on the appeal. In the event that the Plan has purchased Claim Fiduciary Services, this provision shall not apply. (viii)Make available to plan participants and providers claim submission forms for use by Plan Participants in submitting claims to HMA. (ix)Apply payment integrity programs and services as outlined in the Claims administrative Fees and/or Client Intent documents. Such programs and