Orange County NC Website
Browse       Search
8 <br /> 3.2 Sponsor Cooperation. Sponsor acknowledges that the effective performance of the Services by <br /> HAI hereunder requires that Sponsor cooperate with HAI in its efforts. Sponsor agrees to cooperate with HAI in <br /> HAI's performance of the Services by furnishing, among other things, timely reports and information in a form and <br /> manner specified by HAI, including,without limitation, the number of Participants covered under the Plan, <br /> identification of Participants, the kinds of benefits to which such Participants are entitled, the dates of eligibility for <br /> such Participants, the geographic distribution of Participants, and such other information as may be necessary for <br /> performance of Services, including without limitation the processing of benefit payments. Sponsor shall provide <br /> HAI continuing access to all books and records necessary for HAI to fulfill its duties hereunder to Sponsor and <br /> Participants. HAI shall not be responsible for any delay in the performance of its duties under this Agreement to <br /> the extent that such delay arises from the failure of Sponsor to provide to HAI any such information on a timely <br /> basis. <br /> 3.3 Emplovee Count. Prior to or on the Effective Date, Sponsor shall furnish HAI a listing of <br /> Employees(the"Employee List"),by zip code of each Employee's place of residence. <br /> (a) Membership File Tape. Sponsor may, in its discretion,elect to provide the Employee <br /> List by membership file tape;provided, however, that if Sponsor has selected HAI in Section__l:1(a)to perform <br /> Claims Management Services hereunder, then Sponsor must provide the Employee List by membership file tape. If <br /> Sponsor provides the Employee List by membership file under this Section 3.3(a), then Sponsor shall provide HAI <br /> with an updated Employee List on membership file tape on a monthly basis. <br /> (b) Otherwise. If Sponsor provides the Employee List by means other than membership file <br /> tape, then if at any time during the Term the number of Employees increases or decreases more than five percent <br /> (5%) relative to the Employee Count, Sponsor shall notify HAI of such change, and the necessary financial <br /> adjustment shall be made in the next billing cycle to reflect the correct Employee Count. Sponsor shall provide <br /> HAI with an updated Employee List at the time of renewal. Upon ten(10)days'written notice from HAI to <br /> Sponsor, HAI shall have the right to engage an independent party to audit the operations of Sponsor at any time <br /> during Sponsor's normal business hours for the sole purpose of verifying the accuracy of the Employee Count. <br /> 3.4 Provision of Services. <br /> (a) Generally. HAI, in its sole discretion, shall provide the Services hereunder either from <br /> its employees or the employees of an Affiliate of HAI, or by retaining, directly or indirectly through an Affiliate of <br /> HAI, independent contractors to provide the Services. <br /> (b) Professional Services. Except as otherwise provided in this Agreement. HAI shall <br /> provide, in its sole discretion and to the extent permitted by law, all professional services required by this <br /> Agreement through Care Managers, Staff Clinicians or Participating Providers. <br /> (1) Care Managers. "Care Manager" means an employee of HAI or of an <br /> Affiliate of HAI who is a clinical professional licensed or certified under applicable state law to provide treatment <br /> in the areas of mental health and substance abuse. <br /> (2) Staff Clinicians. "Staff Clinician" means an employee of HAI or of an <br /> Affiliate of HAI who is a duly qualified mental health and/or substance abuse treatment provider. For purposes of <br /> this Section, "duly qualified" includes being licensed or certified where required by state law. <br /> (3) Participating Providers. "Participating Provider" means an individual <br /> practitioner, group of practitioners, facility or other specialized provider of services which(i) maintains a practice <br /> or operates a facility or program that provides mental health and/or substance abuse treatment, (ii) has been <br /> credentialed by HAI or an Affiliate or designee of HAI in accordance with HAI's credentialing policies and(iii) has <br /> Human Affairs International.Incorporated 517197 <br /> Services Agreement 6 <br />