2001 S Personnel - NCACC & Cinga for Health Insurance

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� '- b. Claims Filing Limit. The Pool will pay eligible claims incurred up to midnight on the date oftermination, provided such claims are submitted for payment to the Claims Administrator within twelve (12) months of the covered occurrence. Any claims submitted later than twelve (12) months following the date of termination shall be returned to the individual filing the claim. c. Settlement Authority. The Pool or its designee retains sole authority tm adjudicate claims. 7. Termination bythe Pool. This Agreement can be canceled by the Pool only on a renewal date and only after having given written notice by certified mai|, return receipt nequested, to the Member Group at least sixty (60) days before such anniversary date except that the Pool may cancel at any time: (i) after giving ten (1D) days written notice tnthe Member Group if the Member Group has failed to pay any contribution when due. or. (ii) an a result of substantive reorganization or dissolution of the Member. If the Pool chooses not to uonna| for non'poymert, payment of the Member Group's claims will be suspended immediately until the balance due is paid in full. 8' Termination by the Member Group. The Member Group may cancel this Agreement without penalty effective on their renewal date, after giving written notice to the Pool at least thirty (30) days prior to such renewal dote. The Member Group may also terminate the Agreement in the event of an off cycle contribution change as outlined in Article 4above. if the Member Group wishes to terminate the Agreement due to an off cycle contribution change, the Member Group must notify the Pool thirty(30) days prior to the date this contribution change will go into effect, In no event will termination become effective prior to thirty (30) days from the date of notice of termination by the Member Group, 9. Termination Penalty. In the event the Member Group fails to comply with the provisions as outlined in Article 8 above, or if the Pool cancels for non-payment, the Member Group will be liable as follows: (i) if notice to the Pool is less than thirty(30)days before the Member Group's renewal date but prior to the renewal effective date, ten percent � (10%) of the annual estimated renewal contribution will be payable, (ii) if notice to the Pool is after the renewal date, � the full annual estimated renewal contribution will bepayable. | / 10. Member Group Appeals. The Member Group shall have the right to appeal any decision or recommendation to the Pool's Board of Trustees, whose determination will be final. Any appeal shall be made in writing to the Pool's Director of Risk Management within thirty<3O>days of the decision or recommendation. 11' Membership. |n the interest cfproviding effective governance, the Member Group urat least one uf its budgetary contributors must be a member of the North Carolina Association of County Commissioners. 12' Notice. Any written notice to the Pool shall be made by first class mail, postage prepaid, and delivered to the Pool's Director ofRisk Menmgement, North Carolina Association of County Commissioners, PD Box 1488, Raleigh, NC 27602-1488. 13. Sevarmbi|ity. If any portion of this Agreement shall be declared illegal or unenforceable for any veason, the remaining portions shall continue in full force and effect, 14. Special Conditions. m, Orange County offers C|GNAofNorth Carolina (a non'B|uoCmoo and Blue Shield plan) to its employees as a health insurance plan option and may continue to do so on a"grandfather" basis since joining the NCACC Trust, without regard tothe member urpercentage of employees participating in C|GN& Orange County would be expected to comply with any future minimum participation requirements as might be adopted by the NCACC Trust Board of Trustees in the following circumstances; • If Orange County discontinued offering a Trust (Blue Cross and 8|uo Shield administered) health maintenance organization product while continuing to offer a competitors health maintenance organization product; or • |f Orange County discontinued its C|GNA option; or • If Orange County offered additional health insurance carriers for medical coverage.