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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 />to those books and records to permit Administrator to fulfill all of its contractual obligations to Eligible <br />Persons, claimants, and Insurer. Louisiana Rev. Stat. § 22:1644(C). <br />4.5 Insurer Access. Administrator shall maintain and make available to Insurer complete <br />books and records of all transactions performed on behalf of Insurer. Louisiana Rev. Stat. § 22:1644(A). If <br />Administrator administers Covered Products for more than one hundred certificate holders on behalf of <br />Insurer, Insurer may, at least semiannually, conduct a review of the operations of Administrator. At least <br />one such review may be an on-site audit of the operations of Administrator. Louisiana Rev. Stat. § <br />22:1646(C). If Administrator holds any funds in a Claims paying account, Administrator shall not use such <br />funds to pay for any business operating expenses of Administrator. As provided in the Agreement, Admin- <br />istrator shall periodically render an accounting to Insurer detailing all transactions performed by Adminis- <br />trator pertaining to the business underwritten by Insurer. Louisiana Rev. Stat. § 22:1647(A). <br />S. Duties of Insurer. Insurer shall be responsible for determining the Covered Products, premium <br />rates, underwriting criteria, and Claims payment procedures applicable to such coverage and for securing <br />reinsurance, if any. The rules pertaining to these matters must be provided, in writing (as applicable), by <br />Insurer to Administrator. The responsibilities of Administrator as to any of these matters shall be set forth <br />in the Agreement. Louisiana Rev. Stat. § 22:1646(A). It shall be the sole responsibility of Insurer to pro- <br />vide for competent administration of its programs. Louisiana Rev. Stat. § 22:1646(B). <br />6. Payment. <br />6.1 The Parties agree that Administrator will not collect any premiums or charges for insurance <br />paid by or on behalf of an Eligible Person for Insurer. The payment of return premiums or payment of <br />Claims by Insurer to Administrator, if any, shall not be deemed payment to the Eligible Person or claimant <br />until such payments are received by the Eligible Person or claimant. Nothing herein shall limit any right <br />of Insurer against Administrator resulting from its failure to make payments to the Eligible Persons or <br />claimants. Louisiana Rev. Stat. § 22:1643. <br />6.2 To the extent Administrator pays a Claim from money collected for or on behalf of Insurer, <br />such Claim shall be paid by on drafts or checks of and as authorized by Insurer. Louisiana Rev. Stat. § <br />22:1647(D). <br />7. Compensation. <br />7.1 Administrator's compensation under the Agreement is not contingent upon savings ef- <br />fected in the adjustment, settlement, and payment of losses covered by Insurer's obligations. This provision <br />shall not prohibit Administrator from receiving performance-based compensation for providing auditing <br />services and shall not prevent Administrator's compensation from being based on charges collected or the <br />number of Claims paid or processed. Louisiana Rev. Stat. § 22:1648. <br />7.2 Administrator shall disclose to Insurer all charges, fees, and commissions received from <br />all services in connection with the provision of administrative services for Insurer, including any fees or <br />commissions, if any, paid by insurers providing reinsurance. Louisiana Rev. Stat. § 22:1649(C). <br />8. Notice to Eligible Persons. Administrator shall provide a written notice approved by Insurer to <br />Eligible Persons advising them of the identity of, and relationship among, Administrator, Eligible Person, <br />and Insurer. Louisiana Rev. Stat. § 22:1649(A). Any policies, certificates, booklets, termination notices, <br />122 <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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