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2018-015A1
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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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C. SERVICES; FORMULARY; PRICING GUARANTEES. <br />1. Base Administrative Services: The following services are the base administrative services made available <br />to Client and its Members pursuant to the Agreement (including this Exhibit A) (the "Base Administrative <br />Services'), as applicable: <br />• Administration of eligibility submitted via tape or telecommunication <br />• Eligibility maintenance <br />• Client support system for on-line access to current eligibility j <br />• Administration of Client's Plan Design <br />• In -network claims adjudication via on-line claims adjudication system <br />• Designated Account Team <br />• Client clinical and plan consulting, analysis and cost projections <br />• Annual analysis of program utilization and impact of plan design and managed care <br />interventions <br />• Welcome Package and ID Cards for new Members <br />• Standard Member communications <br />• Toll-free telephone access to customer service for the program for use by Members and Client's <br />benefits personnel and representatives ! <br />2. Additional Administrative Services: Client will pay for additional administrative services (the "Additional <br />Administrative Services") beyond those included in the Base Administrative Services that are requested by <br />Client and provided or made available by Administrator under the program as follows: <br />1. Administrative Fees <br />PBM Services —No Additional Fee <br />Customer service for Members <br />Electronic claims processing <br />Electronic/on-line eligibility submission <br />Plan setup <br />Standard coordination of benefits (COB) <br />reject for primary carrier <br />Software training for access to our on-line system(s) <br />FSA eligibility feeds <br />Network Pharmacy Services <br />Pharmacy help desk Pharmacy reimbursement <br />Pharmacy network management Network development (upon request) <br />Home Delivery Services <br />Benefit education Prescription delivery — standard <br />Reporting Services <br />Web -based client reporting — Annual Strategic Account Plan report <br />Ad-hoc desktop parametric reports Billing reports <br />Claims detail extract file electronic CPDP format In u' access to claims processing system <br />Load 12 months claims history for clinical reports and <br />reporting <br />Website Services <br />Express-Scripts.com — access to reporting tools, <br />eligibility update capability, contact directory, sales and <br />marketing information, and benefit and enrollment support <br />secured through Risk Base Authentication <br />Express Previews' enrollment option — available <br />during open enrollment to enable members to evaluate <br />prescription benefit plan options <br />Express-Scripts.com for Members — access to benefit, <br />drug, health and wellness information; prescription <br />ordering capability; and customer service <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />20 <br />
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