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2025-126
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2025-126
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Last modified
6/23/2025 10:28:09 AM
Creation date
6/23/2025 10:23:56 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
06/03/2025
Control Number
2025-126
Agenda Item Number
13.D.1.
Entity Name
RxBenefits, Inc.
Subject
Administrative Services Agreement for the administration of prescription drug benefits
Document Relationships
2025-125
(Agenda)
Path:
\Official Documents\2020's\2025
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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />EXHIBIT A <br />CLIENT APPLICATION <br />January1, 2025 <br />[IMPORTANT — PLEASE READ CAREFULLY: Client should carefully review this Exhibit A, which has <br />been completed by Administrator, in order to ensure its accuracy and completeness. Client shall promptly <br />notify Administrator of any inaccuracy or omission with respect to the terms and conditions, if applicable <br />(including, without limitation, the Client Information in Section A).] <br />A. CLIENT INFORMATION <br />Client's Name: Indian River County Board of County Commissioners <br />Client's Mail Address: 1801 27th Street, Vero Beach, Florida 32960-3365, United States <br />B. PLAN DESIGN, MEMBER COST SHARE <br />Member Cost Share: <br />Please see current Summary of Benefits. <br />Client represents and warrants that the design of Client's Plan as reflected in a Plan Design document for Client <br />("PDD"), accurately reflects the applicable terms of Client's Plan for purposes of this Agreement. Client shall provide <br />Administrator with ninety (90) days prior written notice of any proposed changes to the design of Client's Plan <br />(including the PDD), which changes shall be consistent with the scope and nature of the services to be provided by <br />Administrator under this Agreement. Client agrees that it is responsible for Losses resulting from (a) any failure to <br />implement Plan Design changes which are not communicated in writing to Administrator, or (b) implementation of <br />verbal or written direction regarding exception or overrides to the PDD. In addition, Client shall notify Members of <br />any Plan Design changes prior to the effective date of any such changes as required by applicable law. <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />
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