2012-038 Human Resources - Delta Dental Claims & Administrative fees

Browse Search

2. To enroll as Subscribers all eligible employees or members of the Contractor or entities affiliated with it and to list, if covered, all Eligible Dependents of those employees or members to the extent required under the Plan. The Contractor will provide Delta Dental with eligibility updates to Subscribers and, if applicable, all Eligible Dependents as necessary, but no less than monthly. No retroactive eligibility updates will be accepted for an effective date more than 90 days from the date on which Delta Dental receives notification of the update. If the Contractor requests that a Subscriber's eligibility be terminated retroactively and a claim was incurred for that Subscriber or any Eligible Dependent of the Subscriber after the requested ternunation date, the Subscriber's eligibility will continue until the end of the month in which the claim was incurred. 3. To pernut Delta Dental, by its auditors or other authorized representatives, on reasonable advance written notice, to inspect the Contractor's records to verify the accuracy of Subscribers and Eligible Dependents submitted to Delta Dental. Clerical errors or delays in keeping or relaying data will not invalidate eligibility that would otherwise be validly in force or continue eligibility that would otherwise be validly ternunated, if, after discovery of the errors or delays, an equitable adjustment of the Contractor's payment can be made in a reasonable period of time not to exceed 90 days. 4. To provide each Subscriber with all required privacy notices at such intervals as are required by law, as well as a certificate or summary of benefits provided under this Plan as shown in Exhibit B. Customized benefit literature can be provided by Delta Dental to Contractor for an additional cost. 5. To collect and remit, or to cause to have collected and remitted, to Delta Dental any amounts that the Contractor's employees (or members) are required to pay to Delta Dental under this Plan or any written employment contracts, including amounts for COBRA continuation coverage. Any amounts not collected will be the responsibility of the Contractor. Should the Contractor collect any amounts paid by employees and not remit them to Delta Dental in a tunely fashion, with the result that an Eligible Person's coverage is lost, the Contractor, not Delta Dental, will be liable for any benefits to which the Eligible Person may have been entitled but for the Contractor's tardy remittance or failure to remit, unless after discovery of the errors or delays, an equitable adjustment of the Contractor's payment can be made in a reasonable period of time not to exceed 90 days. 6. To pay for any agreed upon non-standard reports based on the time and materials needed to create the reports. Section IV. General Provisions A. Independent Contractors. Dentists providing services are independent conixactors, and neither the Contractor nor Delta Dental will be liable for any act or omission of any Dentist, his or her employees or agents, or any person providing dental or other professional services under this Plan. B. Binding Effect. All Dentists and Eligible Persons, by perfornvng or receiving services under this Plan, are bound by all its terms. C. Payment Limitations. Delta Dental will make no payment for dental services if a claim for those services has not been received by Delta Dental within one year after the dental services were furnished. D. Marketin~ Materials. No materials bearing the Delta Dentallogo or other protected Delta Dental trademark, copyright, or other intellectual property will be published or distributed by the Contractor conceming this Plan unless Delta Dental approves the materials in advance. This provision shall not be construed to prohibit Contractor from publishing or distributing informal communications concerning this Plan that merely reference the involvement of Delta Dental in the administration of the Plan. E. Le~a1 Action. No action on a legal claim arising out of or related to this Plan that is not a claim for dental benefits by a Subscriber or an Eligible Dependent may be brought unti130 days after notice of the legal claim has been given to Delta Dental. In addition, no action, including a claim for dental benefits by a Subscriber or Eligible Dependent, may be brought more than three years after the claim first arose. Any Revised 09/2011