Health Net 2009 Annual Report Download - page 560

[ADDENDUM 1
CLAUSES PURSUANT TO N.J. REV. STAT. 17B:27B-6
Notwithstanding any other provision of this agreement, contract or amendment (hereinafter, the “Agreement”), the parties agree to
comply with the requirements set forth in N.J. Rev. Stat. 17B:27B-6. In addition to the provisions of the Agreement that address the
matters required by this Section, the following provisions also apply and are made part of the Agreement.
A. Provision of Enrollment and Eligibility Information. From and after the Effective Date, the Company shall be responsible for
furnishing the Administrator with all necessary member enrollment and eligibility information to perform its obligations under
this Agreement.
B. Notification by Benefits Payer of Modifications in Benefit Payer’s Benefits Plan. From and after the Effective Date, the
Company will promptly provide the Administrator with a copy of any modification to the Administered Contracts. To the extent
modifications result in a degradation of the Administrator’s ability to comply with the Service Standards, the parties will
cooperate to develop adjustments to the Service Standards with respect to such Administered Contracts, taking into account such
modifications.
C. Respective Liability of the Administrator and Benefits Payer for Payment of Ineligible Claims. For the avoidance of doubt, the
Administrator shall be ultimately liable for the payment of ineligible claims either pursuant to Section 1.4 of the Stock Purchase
Agreement or as otherwise agreed to by the parties.
D. Liability for Overdue Claims Payments. For the avoidance of doubt, the Administrator shall ultimately be liable for the payment
of overdue claims either pursuant to Section 1.4 of the Stock Purchase Agreement or as otherwise agreed to by the parties.
E. Procurement of Reinsurance or Stop-Loss Insurance. The Administrator shall be responsible for the procurement and
maintenance of reinsurance or stop-loss insurance coverage, as appropriate.
F. Maintenance of Appropriate Insurance Coverage by Administrator. The Administrator shall maintain insurance coverage
appropriate for a third party administrator, including, but not be limited to, general liability insurance, valuable papers insurance
and errors and omissions coverage. For the avoidance of doubt, nothing in this Section F shall relieve United from its obligation
to make available to the Company appropriate types and levels of insurance coverage in accordance with Section 8.6 of the
Agreement.]
This Addendum 1 is found only in the Administrative Services Agreement of Health Net of New Jersey, Inc.
20
20