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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 />CALIFORNIA TPA REGULATORY ADDENDUM <br />With respect to the following provisions required by the State of California, "Administrator" shall mean <br />RIGHTWAY, and "Insurer" shall mean "Client" as that term is defined in the Agreement. <br />Notwithstanding anything in the Agreement to the contrary, Administrator and Insurer agree as follows: <br />1. Applicability. This Addendum is required by California Insurance Code § 1759.1 in order to in- <br />clude the requirements of California Insurance Code Sections 1759.2 to 1759.8, to the extent such require- <br />ments are applicable to the Services provided by Administrator under the Agreement and such requirements <br />are not already addressed in the Agreement. This Addendum applies to the extent Eligible Person(s) reside <br />in the State of California and Insurer is subject to California Insurance Code § 740. <br />2. General. In the event of a direct conflict between this Addendum and the Agreement, the applica- <br />ble provisions of this Addendum shall control if required. Absent such direct conflict, the terms and con- <br />ditions of the Agreement shall remain in full force and effect. Capitalized terms not defined in this Adden- <br />dum shall have the same meaning as set forth in the Agreement. This Addendum may be modified from <br />time to time pursuant to the Agreement. <br />3. Payment. <br />3.1 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. Payment of return premiums or Claims by Insurer <br />to Administrator, if any, shall not he deemed payment to the Eligible Person or claimant until such payments <br />are received by the Eligible Person or claimant. Nothing herein shall limit any right of Insurer against <br />Administrator resulting from its failure to make payments to the Eligible Persons or claimants. California <br />Insurance Code § 1759.2. <br />3.2 All Claims paid by Administrator from funds collected on behalf of Insurer shall be paid <br />only on checks or drafts of, or, with the consent of the Eligible Person, by an electronic funds transfer from, <br />and as authorized by Insurer. California Insurance Code § 1759.7. <br />4. Records. <br />4.1 Administrator and Insurer shall retain a copy of the Agreement for the term of the Agree- <br />ment and five (5) years thereafter. California Insurance Code § 1759.1. <br />4.2 Subject to applicable sections of the Agreement, Insurer shall retain the right to continuing <br />access to documentation of all Claims processed sufficient to permit Insurer to fulfill all of its contractual <br />obligations to Eligible Persons. California Insurance Code § 17593(a). <br />4.3 The Insurance Commissioner of the State of California shall have access to the books and <br />records for the purpose of examination, audit, and inspection. California Insurance Code § 1759.3(b). <br />5. Underwriting. The Parties agree that Administrator does not provide any underwriting services <br />to Insurer. Insurer understands and agrees that all underwriting decisions pertaining to the Plan are solely <br />the responsibility of Insurer. California Insurance Code § 1759.5. <br />93 <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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