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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
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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 />4.5 Insurer Access. If Administrator administers Covered Products for more than one hundred <br />certificate holders on behalf of Insurer, Insurer shall, at least semiannually, conduct a review of the opera- <br />tions of Administrator. At least one such review shall be an on-site audit of the operations of Administra- <br />tor. Mo. Rev. Stat. § 376.1084(3). <br />4.6 In the event Insurer and Administrator cancel the Agreement, notwithstanding the provi- <br />sions of the Agreement and this Addendum, Administrator, in its sole discretion, may, by written agreement <br />with Insurer, transfer all records to a new administrator rather than retain them for five (5) years. In such a <br />case, the new administrator shall acknowledge, in writing, that it is responsible for retaining the records of <br />Administrator as required by Missouri Statutes § 376.1082(1). Mo. Rev. Stat. § 376.1082(4). <br />5. 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. Missouri Statutes § 376.1084(1). It shall be the sole responsibility of Insurer to provide <br />for competent administration of its programs. Missouri Statutes § 376.1084(2). In cases where Adminis- <br />trator administers Covered Products for more than one hundred certificate holders on behalf of Insurer, <br />Insurer shall, at least semiannually, conduct a review of the operations of Administrator. At least one such <br />review shall be an on-site audit of the operations of Administrator. Mo. Rev. Stat. § 376.1084(3). <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 any Eligible Person for Insurer. The payment of return premiums or Claims by <br />Insurer to Administrator, if any, shall not be deemed payment to the Eligible Person or claimant until such <br />payments are received by the Eligible Person or claimant. Nothing herein shall limit any right of Insurer <br />against Administrator resulting from its failure to make payments to Insurer, Eligible Persons or claim- <br />ants. Mo. Rev. Stat. § 376.1080. <br />6.2 To the extent Administrator pays a Claim from funds collected for or on behalf of Insurer, <br />such Claim shall be paid only on drafts or checks of, and as authorized by, Insurer, Mo. Rev. Stat. § <br />376.1085(4). <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. Mo. Rev. Stat. § 376.1087. <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 paid by insurers providing reinsurance. Mo. Rev. Stat. § 376.1088(3). <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 />132 <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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