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2003-040 Resolution
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2003-040 Resolution
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1/10/2014 3:23:34 PM
Creation date
12/26/2013 9:36:07 AM
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North Olmsted Legislation
Legislation Number
2003-040
Legislation Date
3/18/2003
Year
2003
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9. OTHER OBLIGATIONS OF THE PLAN SPONSOR <br />AUDITS: Should the Plan Sponsor perform audits of the Claims Administrator <br />or any Provider and receive any reimbursement or refund as a result of such <br />audits, the Plan Sponsor agrees that it will reimburse Medical Mutual of Ohio for <br />amounts previously paid by Medical Mutual of Ohio under this or a previous Stop <br />Loss Contract. The Plan Sponsor cannot apply any recovered amounts toward <br />Stop Loss liabilities, deductibles, thresholds or maximums. <br />CLAIMS ADMINISTRATOR: While this Contract is in force, the Plan Sponsor <br />shall employ, at its own expense, the services of the Claims Administrator. The <br />services of the Claims Administrator cannot be terminated by the Plan Sponsor <br />without the advance written notification to and consent of Medical Mutual of Ohio, <br />or the Contract may subject to the Termination provisions set forth In Section 8 of <br />this Contract. <br />ELIGIBILITY: Only claims for Covered Persons, as defined in the Plan, are <br />eligible for payment under this Contract. <br />ENROLLMENT LEVELS: The Plan Sponsor agrees to meet or exceed a 75% <br />enrollment level of its net eligible Participants and to enroll under this Contract at <br />least fifty percent (50%) of all total eligible Participants. To determine the number <br />of net eligible Participants, the Plan Sponsor may exclude from the total count of <br />eligible Participants any employee who waives coverage under the Plan if such <br />employee is enrolled in a spouse's employer-sponsored health care plan or is <br />enrolled as an employee in another program for health care benefits. <br />MAJOR CASE MANAGEMENT: The Plan Sponsor agrees to utilize any <br />available cost savings or case management programs and to take full advantage <br />of any available discounts, even if such programs require the payment of access <br />fees. <br />With the prior consent of an affected Covered Person, Medical Mutual of Ohio <br />may elect to utilize the services of personnel skilled in major case management <br />for high cost potential cases. The Plan Sponsor must agree to cooperate with <br />the use of these services. <br />RECORDS: the Plan Sponsor and/or the Claims Administrator shall forward, all <br />information required by Medical Mutual of Ohio in connection with the <br />administration of this Contract and for the determination of premi_ums and <br />payments. The Plan Sponsor and/or the Claims Administrator shall make <br />available for inspection by Medical Mutual of Ohio all records that have a bearing <br />on the reinsurance hereunder. Such records shall be maintained and open to <br />Medical Mutual of Ohio for inspection at any time for up to three years after the <br />termination of this Contract. <br />CCX0202 Page 7 090102 <br />03 eCityofN orthOlmstedSL <br />
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