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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 />12. Compensation. Administrator and Insurer agree that compensation to Administrator for any Plans <br />in which Administrator adjusts or settles Claims shall in no way be contingent on Claims experience. Ad- <br />ministrator and Insurer further agree that this provision does not prevent Administrator's compensation <br />from being based on charges collected or the number of Claims paid or processed. NM Stat. Ann. § 59A - <br />12A -11. Insurer shall not pay, directly or indirectly, Administrator for service as an administrator within <br />this state, unless Administrator is duly licensed to transact such business in the state of New Mexico. N.M. <br />Code R. § 13.4.5.21. <br />13. Fiduciary Account. <br />13.1 The Parties agree that Administrator will not collect insurance charges or premiums on <br />behalf of or for Insurer. Return premiums received from Insurer, if any, shall be held by Administrator in <br />a fiduciary capacity. Such funds shall be immediately remitted to the person or persons entitled thereto or <br />shall be deposited promptly in a fiduciary bank account established and maintained by Administrator. If <br />charges or premiums so deposited have been collected on behalf of or for more than one insurer, Adminis- <br />trator shall cause the bank in which such fiduciary account is maintained to keep records, clearly recording <br />the deposits in and withdrawals from such account on behalf of or for each insurer. N.M. Stat. § 59A -12A - <br />9(A). <br />13.2 Administrator shall promptly obtain and keep copies of all such records and, upon request <br />of Insurer, shall furnish Insurer with copies of all records pertaining to deposits and withdrawals on behalf <br />of or for Insurer. N.M. Stat. § 59A -12A -9(B). <br />13.3 Administrator shall not pay any Claim by withdrawals from such fiduciary account. With- <br />drawals from such account shall be made, as provided in the Agreement, for: (1) remittance to Insurer <br />entitled thereto; (2) deposit in an account maintained in the name of such Insurer; (3) transfer to and deposit <br />in a Claims paying account, with Claims to be paid as provided in N.M. Stat. § 59A -12A-10; (4) payment <br />to a group policyholder for remittance to the insurer entitled thereto; (5) payment to Administrator of its <br />commission, fees or charges; or (6) remittance of return premiums to the person or persons entitled <br />thereto. N.M. Stat. Ann. § 59A -12A-9 (C). <br />14. Responsibilities of Insurer. Insurer shall be responsible for determining the Covered Products, <br />premium rates, underwriting criteria and Claims payment procedures applicable to its coverage and for <br />securing reinsurance, if any. It is the ultimate responsibility of Insurer to provide for competent administra- <br />tion of its programs. In cases where Administrator administers Covered Products for more than one hun- <br />dred (100) certificate holders on behalf of Insurer, Insurer shall maintain for a minimum of at least three <br />years any reviews conducted of the operations of Administrator, and shall produce the records pertaining <br />to the review at the request of the superintendent. N.M. Code R. § 13.4.5.22. <br />15. Termination. Insurer or Administrator may upon written notice, terminate the Agreement for <br />cause as provided in the Agreement. Insurer may suspend the underwriting authority of Administrator dur- <br />ing the pendency of any dispute regarding the cause for termination of the Agreement. Insurer must fulfill <br />any lawful obligations with respect to policies or Claims affected by the Agreement, regardless of any <br />dispute between Insurer and Administrator. N.M. Code R. § I3.4.5.20(B). <br />142 <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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