Healthcare Management Administrators (HMA) 2/20/2025

HMA TPA Agreement Page 4 4/22 services include, but are not limited to, coordination of benefits activities, facility and coding review on eligible claims as per our internal thresholds, medical necessity reviews, subrogation and other collection activities, and collection of overpayments or improper payments made to any Participants, as reasonably possible. HMA shall perform the necessary services with respect to obtaining recoveries, including, but not limited to fraud, waste, and abuse claim review services, third party claim recovery/overpayment recovery services, sending questionnaires, providing and receiving documentation, as applicable. HMA has the discretion to utilize the services of a third-party in connection with such matters. Plan Sponsor acknowledges that waiver or reduction of a recovery may be necessary as a result of the particular facts or law applicable to the recovery. HMA shall refer requests for negotiation or waiver of a claim to the Plan Sponsor for final determination. There may be fees for these services as outlined in the Claim Administrative Fee Schedule and/or the Client Intent. In the event that additional recovery services are needed, HMA, subject to the approval of the Plan Sponsor, shall arrange for the purchase of such recovery services. Any fees charged to HMA for recovery services will be passed on to the Plan Sponsor for payment. HMA reserves the right to retain a nominal percentage of the net recovery to the Plan Sponsor to compensate HMA for increased administrative fees associated with recovery services. (x)Screen claims to avoid duplicate payments and maintain procedures that facilitate consistency in claims processing in accordance with the Plan. (xi)Prepare such reports concerning Plan Participants’ benefits as the Plan Sponsor, the Plan Administrator and HMA may hereafter agree upon. (xii)HMA shall coordinate for the approval of claims for payment by the Plan Sponsor. Once Plan Sponsor has approved the claims via issuing the requested funding then HMA shall pay from the Plan Sponsor bank account, if provided, or shall issue an order to the Plan Sponsor or other person with authority to disburse funds of the Plan Sponsor to pay the expenses of operation of the Plan incurred pursuant to the performance of this Agreement (excluding Plan administration fees unless specifically authorized)HMA shall honor any assignment of benefits of a person eligible for benefits under Plan to any person or institution, which is a proper and qualified assignee if applicable under the terms of the Plan. (d)Initial Transition services. When the Plan Administrator desires that HMA begin performance under this Agreement prior to completion and execution of a restated SPD, HMA shall perform claims processing in accordance with the Plan Sponsor’s existing SPD. In no event will HMA process any claims on a “run-in” basis. Nor will claims be processed utilizing a prior carrier/administrator’s network discounts. All claims will be adjudicated in accordance with the terms of the network(s) accessed through HMA. The Plan Sponsor hereby acknowledges that any claims which require reprocessing as a result of changes between the prior SPD or the Plan Sponsor’s instructions and the restated executed SPD will be subject to an additional reprocessing fee at HMA’s discretion. The Plan Sponsor further acknowledges that claims which are paid pursuant to the benefits and exclusions described within the