Plan Interpretation. EDH will administer and adjudicate Claims in accordance with this Agreement, but will have no discretionary authority to interpret or manage the Plan. Sponsor, and not EDH, shall be responsible for determining the benefits, premium rates, underwriting criteria, acquisition of reinsurance, and other procedures applicable to its programs, including the Plan. Sponsor, in its capacity as administrator of the Plan, shall be the final arbitrator and have the final authority and responsibility regarding interpretation, application, and competent administration of its programs, including the Plan, and may delegate such authority to a Plan Administrator. Accordingly, upon reasonable request of EDH, Sponsor or such Plan Administrator will resolve all ambiguities and disputes relating to the Plan Documents, eligibility of a Participant, Plan coverage, denial of Claims, or any other Plan interpretation questions reasonably posed by EDH. If adjudication of a Claim requires interpretation of ambiguous language in the Plan Documents, and Sponsor or its Plan Administrator has not previously indicated to the EDH the proper interpretation of the language, then Sponsor or its Plan Administrator will be responsible for resolving the ambiguity or any other dispute. In any event, Sponsor’s or its Plan Administrator’s decision as to any Claim (whether or not it involves a Plan ambiguity or other dispute) will be final and binding.
Appears in 2 contracts
Sources: Surgeryplus Services Agreement, Surgeryplus Services Agreement
Plan Interpretation. EDH will administer and adjudicate Claims in accordance with this Agreement, Agreement but will have no discretionary authority to interpret or manage the Plan. Sponsor, and not EDH, shall be responsible for determining the benefits, premium rates, underwriting criteria, acquisition of reinsurance, and other procedures applicable to its programs, including the Plan. Sponsor, in its capacity as administrator of the Plan, shall be the final arbitrator and have the final authority and responsibility regarding interpretation, application, and competent administration of its programs, including the Plan, and may delegate such authority to a Plan Administrator. Accordingly, upon reasonable request of EDH, Sponsor or such Plan Administrator will resolve all ambiguities and disputes relating to the Plan Documents, eligibility of a Participant, Plan coverage, denial of Claims, or any other Plan interpretation questions reasonably posed by EDH. If adjudication of a Claim requires interpretation of ambiguous language in the Plan Documents, and Sponsor or its Plan Administrator has not previously indicated to the EDH the proper interpretation of the language, then Sponsor or its Plan Administrator will be responsible for resolving the ambiguity or any other dispute. In any event, Sponsor’s or its Plan Administrator’s decision as to any Claim (whether or not it involves a Plan ambiguity or other dispute) will be final and binding.
Appears in 1 contract
Sources: Surgeryplus Services Agreement