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Res 2016-077/approving an administrative services agreement with United Healthcare Services, Inc. for the provision of medical, pharmacy, dental, flexible spending accounts (fsa), retiree, online enrollment tool and cobra benefits administration in a tot
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Res 2016-077/approving an administrative services agreement with United Healthcare Services, Inc. for the provision of medical, pharmacy, dental, flexible spending accounts (fsa), retiree, online enrollment tool and cobra benefits administration in a tot
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Resolutions
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Approving
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2016-77
Date
6/21/2016
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compensation. If at any time Customer does not find the subcontractor compensation acceptable, Customer may <br />terminate the medical benefit Rebates services after thirty (30) calendar days advance written notice to United. <br />Section A5 Claims Determinations and Appeals <br />Claim Procedures. Customer appoints United a named fiduciary under the Plan with respect to (i) performing initial <br />benefit determinations and payment and (ii) performing the fair and impartial review of first level internal appeals. <br />As such, Customer delegates to United the discretionary authority to (i) construe and interpret the terms of the Plan <br />and (ii) determine the validity of charges submitted to United under the Plan. This delegation is subject to Customer's <br />retention of full responsibility as Plan Administrator for the final review of adverse benefit determinations and to make <br />final, binding determinations concerning the availability of Plan benefits under the Plan's internal appeals process. If <br />United denies a Plan benefit claim, in whole or in part, United will notify the claimant of the adverse benefit <br />determination and the claimant shall have the appeal rights set forth in the Summary Plan Description, and/or those <br />which are required under applicable law. If a second internal appeal is requested, United will forward to Customer <br />documentation regarding the adverse benefit determination necessary for Customer to conduct the final internal <br />appeal. Customer will notify United and the claimant of the outcome of the final internal appeal. Customer's <br />determination will be final and binding on the claimant and all other interested parties, except as otherwise provided <br />under the external review program described in this Section. <br />Appeals of Urgent Care Claims. Except as otherwise provided in this Agreement, Customer appoints United a <br />named fiduciary under the Plan with respect to appeals of a claim for medical services and supplies which meets <br />ERISA's definition of Urgent Care Claim ( "Urgent Care Claims "). United will conduct one review of a denied Urgent <br />Care Claim and issue a final determination as soon as possible, in accordance with applicable law. Customer delegates <br />to United the discretionary authority to construe and interpret the terms of the Plan and to make final binding <br />determinations concerning the availability of Plan benefits regarding these claims. United acknowledges that the <br />Customer is not subject to ERISA. <br />External Review Program. Customer will notify claimants of the option to request an external review of adverse <br />benefit determinations following the required internal appeal process and provide the necessary information for them <br />to contact United. United will, in accordance with applicable law: (i) provide claimant with the necessary procedures <br />to obtain the review (ii) coordinate submission of the claimant's case to an independent review organization, and (iii) <br />direct the independent review organization to notify the claimant of the final external review decision. A fee will <br />apply beyond the maximum number of free reviews, as listed in Exhibit B, Fees. <br />Section A6 Systems Access <br />Access. United grants Customer the nonexclusive, nontransferable right to access and use the functionalities contained <br />within the Systems, under the terms specified in this Agreement. Customer agrees that all rights, title, and interest in <br />the Systems and all rights in patents, copyrights, trademarks, and trade secrets encompassed in the Systems will remain <br />United's. To obtain access to the Systems, Customer will obtain, and be responsible for maintaining, at no expense <br />to United, the hardware, software, and Internet browser requirements United provides to Customer, including any <br />amendments thereto. Customer will be responsible for obtaining an Internet Service Provider or other access to the <br />Internet. Customer will not (i) access Systems or use, copy, reproduce, modify, or excerpt any Systems documentation <br />provided by United in order to access or utilize Systems, for purposes other than as expressly permitted under this <br />Agreement or (ii) share, transfer or lease Customer's right to access and use Systems, to any other person or entity <br />which is not a party to this Agreement. Customer may designate any third party, with prior approval from United, to <br />access Systems on Customer's behalf, provided the third party agrees to these terms and conditions of Systems access <br />and Customer assumes joint responsibility for such access. <br />Security Procedures. Customer will use commercially reasonable physical and software -based measures to protect <br />the passwords and user IDs provided by United for access to and use of any web site provided in connection with the <br />services. Customer shall use commercially reasonable anti -virus software, intrusion detection and prevention system, <br />secure file transfer and connectivity protocols to protect any email and confidential communications provided to <br />United, and maintain appropriate logs and monitoring of system activity, Customer shall notify United within a <br />reasonable timeframe of any (a) unauthorized access or damage, including damage caused by computer viruses <br />14 <br />
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