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2018-015A1
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Last modified
12/21/2020 11:37:35 AM
Creation date
5/9/2018 1:10:52 PM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
01/23/2018
Control Number
2018-015A1
Agenda Item Number
12.D.1.
Entity Name
RxBenefits
Subject
Administrative Services Agreement for Prescription Benefits
Alternate Name
Health Insurance Drug Benefits
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ARTICLE IX — ERISA, COBRA AND HIPAA DUTIES <br />A. ERISA. If Client's offering of the Prescription Drug Program provided for in this Agreement constitutes <br />part of a "welfare plan" within the meaning of Section 3(1) of the ERISA, it is understood and agreed that <br />the duties of Client and Administrator are as follows: <br />I. PIan and Summary Description: It shall be the duty of Client (and not the duty of Administrator) to <br />furnish any Plan, summary plan description or summary of material modifications to participants <br />and beneficiaries as required by ERISA and any regulations under it. It shall be the duty of <br />Administrator to provide Client, upon request, with a summary of benefits available under the Plan <br />for use in conjunction with the summary plan description and summary of material modifications. <br />2. Annual and Summary Annual Reports: It shall be the duty of Client to furnish any annual reports <br />to participants and/or governmental agencies as required by ERISA, the Internal Revenue Code and <br />any regulations thereunder. It shall be the duty of Administrator to send to Client, upon Client's <br />reasonable request, such information which Administrator has within its possession as will permit <br />Client to make the annual reports. It shall be the duty of Client to provide the Members with <br />summary annual reports as required by ERISA and any regulations under it. <br />3. Plan Administrator: It is expressly understood and agreed by the Parties to this Agreement that any <br />and all .duties assigned by ERISA and any regulations thereunder to the Plan Administrator <br />including, but not limited to, those duties specified in the Plan shall be deemed for purposes of this <br />Agreement as duties of Client and not those of Administrator. <br />B. Continuation Coverage. It is also expressly understood and agreed by the Parties to this Agreement that <br />the compliance with continuation coverage requirements imposed on group health plans by ERISA, the <br />Internal Revenue Code and the Public Health Service Act (including the regulations thereunder) shall be the <br />sole obligation of Client under this Agreement and not the obligation of Administrator. Further, <br />Administrator will not accept payment directly from any employee or former employee (or dependent of such <br />employee or former employee) who is eligible for continuation coverage under the Plan. It shall be the <br />responsibility of Client (and not Administrator), or such other third party administrator handling the group <br />health plan of which the Prescription Drug Program is a part, to collect the premiums due from the employee <br />or former employee (or dependent of such employee or former employee) for continuation coverage and to <br />satisfy any and all other COBRA duties and responsibilities relating thereto. <br />C. HIPAA and Privacy and Security. <br />1. Client also shall be solely responsible for any and all duties and responsibilities under HIPAA and <br />similar state law that may apply to the Prescription Drug Program offered under this Agreement at <br />any time, including but not limited to those provisions relating to portability, non-discrimination, <br />privacy and security. The Parties will cause a HIPAA Business Associate Agreement in the form <br />attached hereto as Exhibit B to be signed by their respective authorized representatives as of the <br />Effective Date and will comply with the obligations required of the Parties therein. <br />2. Prescription Drug Claims, as well as eligibility information, which is de -identified in accordance <br />with HIPAA and other applicable law, and which is not identifiable on a Member basis, may be <br />used, disclosed, reproduced, adapted or sold by PBM. Such de -identified data may be provided to <br />nationally recognized data integration firms to support appropriate administration of PBM's drug <br />management programs as this benchmarking data enables PBM to compare against other drug <br />population sets and seek to improve programs and services for clients. <br />IN WITNESS WHEREOF, Administrator and Client have caused this Agreement to be executed and <br />delivered by their respective authorized representatives as of the Effective Date. <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />17 <br />
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