2025-126D - Laserfiche WebLink

Home Browse Search

Docusign Envelope ID: 921F7A24-D5CE-4BCC-9F3C-5E7844661266 INDIANA TPA REGULATORY ADDENDUM With respect to the following provisions required by the State of Indiana, "Administrator" shall mean RIGHTWAY, and "Insurer" shall mean Client as that term is defined in the Agreement. Notwithstanding anything in the Agreement to the contrary, Administrator and Insurer agree as follows: 1. Applicability. This Addendum is required in order to include the terms mandated by Indiana Code Sections 27-1-25-2, et seq. This Addendum applies to the extent Eligible Person(s) reside in the State of Indiana, Insurer is an "insurer" as defined in Indiana Code Section 27-1-25-1, such requirements are appli- cable to the services provided by Administrator under the Agreement, and such requirements are not already addressed in the Agreement. 2. General. In the event of a direct conflict between this Addendum and the Agreement, the applica- ble provisions of this Addendum shall control if required. Absent such direct conflict, the terms and con- ditions of the Agreement shall remain in full force and effect. Capitalized terms not defined in this Adden- dum shall have the same meaning as set forth in the Agreement. This Addendum may be modified from time to time pursuant to the Agreement. 3. Written Agreement. The written Agreement between Administrator and Insurer shall be in place before Administrator may act in the capacity of a third -party administrator to Insurer. The functions that Administrator will perform on behalf Insurer, as well as the lines, classes, and types of coverage that Ad- ministrator is authorized to administer on behalf of Insurer, shall be as stated in the written Agreement. Ad- ministrator and Insurer shall each maintain the Agreement as part of their official records for a minimum of five (5) years after termination of the Agreement. The Agreement may be filed with the Commissioner of the Insurance Department of the State of Indiana in connection with applicable licensing procedures. Ind. Code §§ 27 -1 -25 -2(a) -(b), (d) -(e). 4. Advertising. Administrator shall use advertising relating to the business underwritten by Insurer only to the extent that the advertising has been approved in writing by Insurer before the advertising is used. Ind. Code § 27-1-25-5. 5. Insurer Responsibilities. Insurer shall be responsible for: (1) determining the Covered Products, premium rates, underwriting criteria, and Claims payment procedures that apply to the coverage; and (2) securing reinsurance. Contemporaneously with execution of the Agreement, Insurer shall provide Admin- istrator with the rules that Administrator must follow in administering the coverage and the responsibilities of Administrator as to administering the coverage. Insurer retains sole responsibility for the competent administration of benefit programs provided by Insurer. To the extent Administrator administers Covered Products for more than one hundred (100) Eligible Persons on behalf of Insurer, then Insurer shall, not less than semiannually, review the operations of Administrator, with at least one (1) of the semiannual reviews to be an onsite audit of Administrator operations. Ind. Code § 27-1-25-5.5. 6. Accounting and Claims Payments. 6.1 The Parties agree that Administrator does not collect premiums on behalf of Insurer. Ad- ministrator shall act as a fiduciary in collecting or returning other charges for Insurer, if applicable. Funds collected by Administrator shall be immediately remitted to the person entitled to the funds or deposited in 110 This document is CONFIDENTIAL AND PROPRIETARY to RIGHTWAY Healthcare, Inc. and may not be reproduced, transmitted, published, or disclosed to others without the prior written authorization of RIGHTWAY Healthcare, Inc.