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HMA TPA Agreement Page 5 4/22 <br />prior SPD or the Plan Sponsor’s instructions, may be determined to be ineligible <br />for reimbursement pursuant to any excess loss policy. <br />(e)Transparency Regulation Support. <br />To the extent the Plan is obligated under 26 CFR Part 54 [TD 9929], 29 CFR Part <br />2590, and 45 CFR Parts 147 and 158 (the “Transparency Regulations”) to make <br />filings or obtain approval from any state or other jurisdictional governing agency, <br />HMA will notify and assist the Plan regarding such filings. Subject to the limitation <br />described below, HMA agrees to provide, on behalf of the Plan, all publications of <br />information and disclosures (collectively, “the Disclosures”) necessitated by the <br />price transparency requirements set forth in the Transparency Regulations and the <br />Consolidated Appropriations Act of 2021 Divisions BB and EE, amending the Public <br />Health Service Act, the Internal Revenue Code, and the Employee Retirement <br />Income Security Act (“CAA Transparency Provisions”). Notwithstanding the <br />foregoing, HMA shall have no obligation to make the Disclosures with respect to <br />benefits or services for which HMA is not supporting the Plan (i.e. dialysis carve- <br />outs and Pharmacy services, except those covered under an HMA partner <br />Pharmacy Benefit Manager Contract). HMA shall exercise in its sole discretion in <br />interpreting the applicable federal standards for the Disclosures on behalf of the <br />Plan pursuant to the Transparency Regulations and CAA Transparency Provisions. <br />Under no circumstances shall HMA be liable for the direct or indirect payment of <br />Plan benefits, regardless of fault. <br />(f)HB 1065 & No Surprises Act/IDR Balance Billing Support. <br />If the Plan files directly with the State to Opt-in to the HB 1065 program, HMA <br />shall provide standard claim processing services to those qualifying claims. In <br />addition, HMA shall adjust processing to apply pricing as required by 1065 and No <br />Surprises Act regulations and to assist the Plan with good-faith negotiation and <br />arbitration case processing. HMA will apply the outcome of any arbitrator’s <br />decision on the Plan’s behalf. The Plan retains all funding obligations for 1065 <br />and No Surprises Act claims including all ancillary fees and expenses, including but <br />limited to any negotiation support fees charged by HMA and/or its vendor partner. <br />HMA makes no representations implied or otherwise around the Plan’s Stop Loss <br />Carrier’s independent decision to cover the claim amounts included in an award <br />issued by an arbitrator. The Plan should take steps to ensure that their Stop Loss <br />Partner will cover any arbitration award issued in favor of a provider. <br />(g)Stop Loss administration support. <br />Provide Stop Loss administration support to the Plan Sponsor. HMA may accept <br />pre-funding checks from Plan Sponsor’s Stop Loss carrier on behalf of the Plan <br />Sponsor, however such acceptance shall not deem HMA a Plan Fiduciary. Plan <br />Sponsor/Administrator retains all fiduciary responsibility associated with the Plan. <br />HMA shall submit reimbursement requests to Plan Sponsor’s stop loss carrier on <br />behalf of Plan Sponsor, however, submission for reimbursement does not <br />guarantee payment under the stop loss policy, and HMA bears no responsibility for <br />the actions of any stop loss carrier. HMA’s support will include, to the extent <br />requested by the Plan Sponsor, facilitating claim submission for prescription drug <br />claims to the Plan’s stop loss carrier. Plan Sponsor acknowledges and agrees that <br />timing of prescription claims including but not limited to refills and grace periods, <br />invoicing of claims, obtainment of any prior authorizations, benefit alignment with