Common use of Third Party Administrators Clause in Contracts

Third Party Administrators. The Plan Administrator has engaged certain third party administrators (TPA) to assist in the administration of the Plan. Under these TPA arrangements, the Employer has agreed to provide the following information to you (in compliance with the Third Party Administrator Act (e.g. MCL 550.901 et seq): This Basic SPD and Plan document, the Adoption Agreement, and the applicable Benefits Guides, describe your benefits under each benefit program and whether such benefits are self-funded through the general assets of the Employer or fully- insured through an insurance company. If a benefit program is self-funded from the general assets of the Employer (and not fully insured), and in the event such self-funded program or the Employer does not ultimately pay medical expenses that are eligible for payment under the benefit program for any reason, the individuals covered by the Plan may be liable for those expenses. The TPA merely processes claims and does not insure that any medical expenses of individuals covered by the benefit program will be paid. Complete and proper claims for benefits made by individuals covered by the Plan will be promptly processed but that in the event there are delays in processing claims, the individuals covered by the benefit program shall have no greater rights to interest or other remedies against the TPA than as otherwise afforded them by law.