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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 />Commissioner shall keep confidential any trade secrets contained in those books and records, including the <br />identity and addresses of policyholders and certificate holders, except that the Commissioner may use the <br />information in any judicial or administrative proceeding instituted against Administrator. N.C. Gen. Stat. <br />§ 58-56-16(b). <br />7.3 Insurer shall own the records generated by Administrator pertaining to Insurer, but Admin- <br />istrator shall retain the right to continuing access to books and records to permit Administrator to fulfill all <br />of its contractual obligations to Eligible Persons, claimants, and Insurer. N.C. Gen. Stat. § 58-56-16(c). <br />7.4 In the event Insurer and Administrator cancel the Agreement, notwithstanding the prior <br />provisions of this section, Administrator may, by written agreement with Insurer, transfer all records to a <br />new administrator rather than retain them for five years. In this case, the new administrator shall <br />acknowledge, in writing, that it is responsible for retaining the records of Administrator as required in this <br />section. N.C. Gen. Stat. § 58-56-16(d). <br />8. Approval of Advertising. Administrator may use only the advertising pertaining to the business <br />underwritten by Insurer that has been approved in writing by Insurer in advance of its use. N.C. Gen. Stat. <br />§ 58-56-21. <br />4. Responsibilities of Administrator. The Agreement sets forth the duties that Administrator is ex- <br />pected to perform on behalf of Insurer and the kinds of insurance for which Administrator is to be authorized <br />to administer. The Parties agree that Administrator does not provide any underwriting services to In- <br />surer. Insurer understands and agrees that all underwriting decisions pertaining to the plan are solely the <br />responsibility of Insurer. N.C. Gen. Stat. § 58-56-6(b). <br />10. Responsibilities of Insurer. <br />10.1 Insurer is responsible for determining the Covered Products, premium rates, underwriting <br />criteria, and Claims payment procedures applicable to the coverage and for securing reinsurance, if <br />any. The rules pertaining to these matters must be provided, in writing (as applicable), by Insurer to Ad- <br />ministrator. The responsibilities of Administrator as to any of these matters shall be set forth in the Agree- <br />ment. It is the sole responsibility of Insurer to provide for competent administration of its programs. N.C. <br />Gen. Stat. § 58 -56 -26(a) -(b). <br />10.2 If Administrator administers Covered Products for more than 100 certificate holders on <br />behalf of Insurer, Insurer shall, at least semiannually, conduct a review of the operations of Administra- <br />tor. At least one semiannual review shall be an on-site audit of the operations of Administrator. Annually, <br />Insurer shall file with the Commissioner a certification of completion of the audits as required by this sec- <br />tion and performed during the previous calendar year, in the format, content, and manner as specified by <br />the Commissioner. Insurer shall maintain in its corporate records documentation of the audits conducted <br />to support its certification of audits for a period of five years or, if Insurer is a domestic insurer, until the <br />completion of the next quinquennial examination. N.C. Gen. Stat. § 58-56-26(c). <br />11. Fiduciary Account and Payment of Claims. <br />11.1. The Parties agree that Administrator is not obligated to collect charges or premiums on <br />behalf of or for Insurer. To the extent any funds are collected by Administrator, these funds shall be imme- <br />diately remitted to the person entitled to them or shall be deposited promptly in a fiduciary account estab- <br />lished and maintained by Administrator in a federally or State Eligible Person financial institution. The <br />144 <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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