2025-126D - Laserfiche WebLink

Home Browse Search

Docusign Envelope ID: 921 F7A24-D5CE-4BCC-9F3C-5E7844661266 MICHIGAN TPA REGULATORY ADDENDUM With respect to the following provisions required by the State of Michigan, "Administrator" shall mean RIGHTWAY, and "Plan Sponsor" shall mean Client as that term is defined in the Agreement. Notwithstanding anything in the Agreement to the contrary, Administrator and Plan Sponsor agree as fol- lows: 1. Applicability. This Addendum is required in order to include the terms mandated by Michigan Compiled Laws § 550.932 to the extent such requirements are applicable to the services provided by Ad- ministrator under the Agreement, and such requirements are not already addressed in the Agreement. This Addendum applies to the extent Eligible Person(s) reside in the State of Michigan, and to the extent that Plan Sponsor is a "plan" or a "benefit plan" as defined in Chapter 550 of the Michigan Compiled Laws. 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 Notice to Eligible Persons. Plan Sponsor shall provide written notice to each Eligible Person containing the following information: 3.1 What Covered Products are being provided. 3.2 Changes in Covered Products. 3.3 The fact that Eligible Persons are not Eligible Persons or are only partially Eligible Persons, as the case may be. 3.4 If the Plan is not insured, the fact that in the event the Plan or the Plan Sponsor does not ultimately pay medical expenses that are eligible for payment under the Plan for any reason, Eligible Per- sons may be liable for those expenses. 3.5 The fact that Administrator merely processes prescription Claims and does not insure that any medical or prescription expenses of Eligible Persons will be paid. 3.6 The fact that complete and proper Claims made by Eligible Persons will be promptly pro- cessed but that in the event there are delays in processing Claims, the Eligible Persons shall have no greater rights to interest or other remedies against Administrator than as otherwise afforded them by law. Michigan Compiled Laws § 550.932(a) - (f). 127 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.