THIS DOCUMENTATION IS MADE A PART OF THE TERMS AND CONDITIONS (THE “TERMS). CAPITALIZED TERMS NOT DEFINED HEREIN HAVE THE MEANING SET FORTH IN THE TERMS.
1. ADMINISTRATIVE SERVICES
1.1 Covered Benefits Administration. Forma will provide administrative services with respect to the Covered Benefits (including specific spending account(s) chosen by the Customer under the Plans), such as Authorized Users enrollment, setting up financial accounts, setting up payroll deductions and funding mechanisms, maintaining separate notional bookkeeping accounts for each Authorized User, managing financial balances, and recovering amounts paid out in excess of the difference between all claim reimbursements of Covered Benefits for Authorized User by Forma, and the funds received from Customer to reimburse Forma for the previous funding of those Authorized User’s Covered Benefits in accordance with the Terms.
1.2 Reimbursements. Forma will process or have processed initial requests for reimbursements in accordance with its standard claims review procedures and applicable law; provided, however, that Forma only will review requests for reimbursement following receipt of all necessary information; and provided, further, that any appeal made by or on behalf of an Authorized User after the initial process will be reviewed and determined by the Customer. Forma will have no discretionary authority with respect to the processing of any claims.
1.3 Enrollment and Eligibility Assistance Services. Forma is not responsible for determining if individuals are eligible under the terms of Covered Benefits. The Customer will review and evaluate information collected from its internal systems, and provide Forma eligibility determinations based on which Forma will enroll Authorized Users in the applicable Covered Benefits. Forma shall have no responsibility with regard to benefits paid (or not paid) in error, or any costs which may be incurred, due to Customer’s failure to timely update or ensure the accuracy of eligibility information.
1.4 Covered Benefits Documents and Forms. To the extent elected and paid for by the Customer in this Agreement, Forma may provide the Customer with sample documents and forms related to administration of the Covered Benefits; provided, however, that it is the Customer’s sole responsibility to ensure that all Covered Benefits documents and forms, including any template or sample documents and forms comply with all applicable laws and regulations.
1.5 Identification Cards and Debit Cards. Based upon information provided by the Customer, Forma will issue identification cards and, if purchased, debit cards to each Authorized User (each, a “Card”). Possession of a Card does not confer any right to services or benefits under the Covered Benefits unless the Card holder is, in fact, an Authorized User. Forma is not responsible for any damages or costs arising from use of such Card by an ineligible individual prior to being notified. Each Card must be used in accordance with the terms of the Covered Benefits, any cardholder agreement, and the substantiation rules of the Code. Forma has no responsibility to monitor the use of such Card, but may deactivate the Card if used other than in accordance with this Section 1.5. Forma will make reasonable attempts to collect repayment of claims paid through the Card for ineligible expenses or offset the ineligible payment against any claims for future eligible expenses.
1.6 Customer Service. Forma will provide customer service offerings for the applicable Authorized Users who are entitled to Covered Benefits or enrolled in a Plan, including providing access to customer service professionals by telephone, online, in person, and by mail, in accordance with then-current policies and procedures.
1.7 Online Services. Forma will maintain a website for Authorized Users to use as a financial administration portal to access funds in the applicable Covered Benefits. For clarity, Forma’s website may also contain links to services provided by third parties, and any use of such third-party services by Customer or its Authorized Users will be subject to additional terms of such third-party services providers. Except as explicitly provided hereunder, Forma will not be responsible for any use by Customer or its Authorized Users of such third-party services.
1.8 Recordkeeping. Forma will maintain the usual and customary books, records, and documents relating to the Plans, for at least the lesser of (i) the term of this Agreement or (ii) 3 years following the date the record was created or received, except as otherwise required by applicable law.