Proposed Clause. To address the foregoing issue, you and your legal counsel may consider adding a restriction on the ability of the PBM to change the PBM Agreement, the pharmacy manual and/or the payment schedule. The Committee has drafted a generic clause, set forth below, which could be considered to be revised and adapted to fit the specific PBM Agreement you wish to amend. The definitions for the capitalized terms used in the clause are included in the attached Appendix A. Notwithstanding any provisions to the contrary contained in the Original Agreement or the Pharmacy Manual:
Proposed Clause. To address the foregoing issue, you and your legal counsel may consider adding an express provision into the PBM Agreement to ensure that you are permitted to collect from patients the difference between your usual and customary retail price and the amount paid by the insurer and/or plan sponser. The Committee has drafted a generic clause which is set forth below which could be considered to be revised and adapted to fit the specific PBM Agreement you wish to amend. The definitions for the capitalized terms used in the clause are included in the attached Appendix A. Notwithstanding any provisions to the contrary contained in the Original Agreement or the Pharmacy Manual, the Provider has the right to collect from a Member, and nothing in the Original Agreement or the Pharmacy Manual shall restrict the Provider from collecting from a Member, the difference between the Provider’s Usual and Customary Retail Price and the amount paid by the Payor to the Provider for a Covered Medication dispensed to such Member or for a Covered Service provided to such Member, as applicable (including in such difference the amount of the applicable Copayment).
Proposed Clause. To address the foregoing issue, you and your legal counsel may wish to consider including an obligation for the PBMs to work to ensure that system design features or system changes made by the PBMs are able to adjudicate in real time. The Committee has drafted a generic clause which is set forth below which could be considered to be revised and adapted to fit the specific PBM Agreement you wish to amend. The definitions for the capitalized terms used in the clause are included in the attached Appendix A. Notwithstanding any provisions to the contrary contained in the Original Agreement or the Pharmacy Manual, the Payor shall use its best efforts to ensure that it will be able to adjudicate on-line Claims in real time using the Claims Standard prior to its implementation of any plan design features or any system changes.
Proposed Clause. To address the foregoing issue, you and your legal counsel may consider including provisions in the PBM Agreements that specifically address the scope of audit. The Committee has drafted a generic clause based on the Quebec scope of audit clause which is set forth below which could be considered to be revised and adapted to fit the specific PBM Agreement you wish to amend. The definitions for the capitalized terms used in the clause are included in the attached Appendix A.
Proposed Clause. The expression ‘material default’ and ‘material adverse effect’ should be explicitly defined. Rationale: - As per Article 35.1.1(a), Lessor’s default includes ‘material default’ in complying with any of the provisions of this Agreement and such default has a ‘material adverse effect’ on DMRC. The expression Please follow tender condition(s) ‘material adverse effect’ has been defined to mean act or event that causes a material financial burden or loss. However, the parameters to decide whether a default is material, are not laid down. Even the Expression ‘Material Adverse Effect’ has to be objectively defined.
Proposed Clause. The Lessor shall, within 30 (thirty) 180 (One Hundred Eighty) days of the close of each quarter of its accounting year, furnish to DMRC its unaudited audited financial results in respect of the preceding quarter Year in the manner and form prescribed by the Securities and Exchange Board of India for publication of quarterly results by the companies listed on a stock exchange. Rationale: - Lessor beingan unlisted company do not have a requirement for doing & Please follow tender condition(s) preparing quarterly financial results and Audited financial report for the respective Financial year are ready only by Sept (6 months of end of financial year).
Proposed Clause. Request to amend the clauses as below: Driving motor shall be of the AC synchronous / asynchronous axial/Radial Please follow tender condition(s). Type designed for special duty cycles required for Elevator operation with no slip rings. It should have a high starting torque, high power factor, efficiency not less than 85% and low energy consumption. As per IEC 60034 – 1, Motor should be suitable for Duty Cycle S5 – 60%. Rationale:- Request to amend the clauses as below: Driving motor shall be of the AC synchronous / asynchronous axial/Radial type designed for special duty cycles required for Elevator operation with no slip rings. It should have a high starting torque, high power factor, efficiency not less than 85% and low energy consumption. As per IEC 60034 – 1, Motor should be suitable for Duty Cycle S5 – 60%.
