Health Net 2009 Annual Report Download - page 518

“Brokers/Consultants” shall mean all Persons who are parties to broker, producer, consultant, agency or other similar
agreements pursuant to which such Persons arrange for sales of Administered Contracts to Customers. The definition of
Brokers/Consultants does not include the Company or Persons who are employees of the Company or its Affiliates.
“Business” means the Company’s business of offering, selling, administering or providing health care benefits under the
Administered Contracts, including the Medicare Business and Medicaid Business, as conducted by the Company prior to the
Effective Date.
“Business Day” means any day which is not a Saturday, Sunday or legal holiday recognized by the United States of America.
“Business Transition Agreement” means the Business Transition Agreement by and between UHG, Parent, the Administrator,
Health Net Life, Inc., UnitedHealthcare Insurance Company, Oxford Health Plans, LLC, and Oxford Health Insurance, Inc. dated as
of the Effective Date.
“Buyer TNE Account” shall have the meaning set forth in Section 2.7.
“CAP” shall have the meaning set forth in Section 3.1(c).
“Chosen Courts” shall have the meaning set forth in Section 18.5.
“Claim” or “Claims” means any and all claims, requests, demands or notices made by or on behalf (whether by Providers or
otherwise) of Contract Holders for the payment of benefits, payment of amounts owed to Providers who have entered into capitated or
other risk-sharing contracts, partial withdrawals, surrenders, returns of Premiums or any other payments or benefits alleged to be due
under or in connection with the Administered Contracts, including interest payable thereon in accordance with applicable Law.
“Claimants” shall have the meaning set forth in Section 6.2(a).
“Commissions” means all commissions, expense allowances, benefit credits, service fees, payments and other fees and
compensation payable to Brokers/Consultants with respect to the Administered Contracts.
“Company” shall have the meaning set forth in the preamble of this Administrative Services Agreement.
“Contract Holders” means with respect to each Administered Contract, any individual Person identified as a policyholder,
enrollee, insured (including any additional insured) or permitted assignee (other than Providers in their capacity as a Provider and not
as a Customer) under the Administered Contract, including any Medicare or Medicaid members.
“Covered Services” shall mean such medical, hospital and other health care services eligible for payment or reimbursement
pursuant to an Administered Contract.
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