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2025-126D
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2025-126D
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Last modified
9/18/2025 10:43:54 AM
Creation date
9/8/2025 1:42:16 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
06/03/2025
Control Number
2025-126D
Agenda Item Number
13.D.1.
Entity Name
Rightway Healthcare, Inc.
Subject
Pharmacy Benefit Management Services Agreement
Document Relationships
2025-126
(Cover Page)
Path:
\Official Documents\2020's\2025
2025-126A
(Cover Page)
Path:
\Official Documents\2020's\2025
2025-126B
(Cover Page)
Path:
\Official Documents\2020's\2025
2025-126C
(Cover Page)
Path:
\Official Documents\2020's\2025
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Docusign Envelope ID: 921 F7A24-D5CE-4BCC-9F3C-5E7844661266 <br />ILLINOIS TPA REGULATORY ADDENDUM <br />With respect to the following provisions required by the State of Illinois, "Administrator" shall mean <br />RIGHTWAY, and "Insurer" shall mean "Client" as that term is defined in the Agreement. <br />Notwithstanding anything in the Agreement to the contrary, Administrator and Insurer agree as follows: <br />1. Applicability. This Addendum is required in order to include the terms mandated by 215 111. <br />Comp. Stat. § 5/511.106 and Ill. Admin. Code tit. 50 § 2051.280 to the extent such requirements are appli- <br />cable to the services provided by Administrator under the Agreement and such requirements are not already <br />addressed in the Agreement. This Addendum applies to the extent Eligible Person(s) reside in the State of <br />Illinois and to the extent that Insurer is an "insurer" or "plan sponsor" as those terms are defined in 215 Ill. <br />Comp. Stat. § 5/511.101. <br />2. General. In the event of a direct conflict between this Addendum and the Agreement, the applica- <br />ble provisions of this Addendum shall control if required. Absent such direct conflict, the terms and con- <br />ditions of the Agreement shall remain in full force and effect. Capitalized terms not defined in this Adden- <br />dum shall have the same meaning as set forth in the Agreement. This Addendum may be modified from <br />time to time pursuant to the Agreement. <br />3. Record Retention. <br />3.1 The Agreement. Administrator and Insurer shall retain, as part of their official records, a <br />copy of the Agreement for the term of the Agreement and five (5) years thereafter. 215 Ill. Comp. Stat. § <br />5/511.106(b). <br />3.2 Maintenance. During the term of the Agreement and for five (5) years thereafter, Admin- <br />istrator shall maintain, at its principal office, adequate books and records among Administrator, Insurer, <br />and Eligible Persons in accordance with generally accepted standards of business recordkeeping. 215 Ill. <br />Comp. Stat. § 5/511.106(c). <br />4. Advertising. Administrator may use advertising relating to the business underwritten by Insurer <br />only to the extent that the advertising has been approved by Insurer before the advertising is used. 215 Ill. <br />Comp. Stat. § 5/511.106(e). <br />5. Notice to Eligible Persons. Upon receipt of instructions from Insurer, Administrator shall <br />promptly deliver any policies, certificates, booklets, termination notices, or other written communications <br />to Eligible Persons. 215 Ill. Comp. Stat. § 5/511.106(f). <br />6. Compensation. Administrator and Insurer agree that the compensation that is payable to Admin- <br />istrator under the Agreement is in no way contingent upon the loss ratio of the plan. This section shall not <br />prohibit Administrator from engaging in cost containment activities with Insurer. All compensation that is <br />payable to Administrator is set forth in the Agreement or any addendum attached thereto. 215 Ill. Comp. <br />Stat. § 5/511.106(g), (h). <br />7. Incentives. To the extent any incentives are provided to Eligible Persons to utilize services of a <br />provider that has entered into an agreement with Administrator, such terms are set forth in the Agree- <br />ment. Ill. Admin. Code tit. 50 § 2051.280(a). <br />108 <br />This document is CONFIDENTIAL AND PROPRIETARY to RIGHTWAY Healthcare, Inc. and may not be reproduced, <br />transmitted, published, or disclosed to others without the prior written authorization of RIGHTWAY Healthcare, Inc. <br />
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