"Pharmacy Benefits Manager's Bond" - Oklahoma

Pharmacy Benefits Manager's Bond is a legal document that was released by the Oklahoma Insurance Department - a government authority operating within Oklahoma.

Form Details:

  • The latest edition currently provided by the Oklahoma Insurance Department;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Oklahoma Insurance Department.

ADVERTISEMENT
ADVERTISEMENT

Download "Pharmacy Benefits Manager's Bond" - Oklahoma

Download PDF

Fill PDF online

Rate (4.6 / 5) 19 votes
Bond No.:_________________
PHARMACY BENEFITS MANAGER’S BOND
OKLAHOMA INSURANCE DEPARTMENT
STATE OF OKLAHOMA
Name of Principal: _____________________________________________________________________
Address of Principal: ___________________________________________________________________
Name of Surety: _______________________________________________________________________
Address of Surety: ________________________________________________________________
State in which Surety is organized: ________________________________________________________
Number of Lives Covered: _________________________________________________________
Minimum Penal Sum: (mark the applicable amount)
____$50,000 (0-5,000 annual lives covered)
____$100,000 (5,001-10,000 annual lives covered)
____$250,000 (10,001 - 25,000 annual lives covered)
____$500,000 (25,001 – 50,000 annual lives covered)
____$750,000 (50,001 -100,000 annual lives covered)
____$1,000,000 (100,001 – Up annual lives covered)
Effective Date: ___________________________________.
KNOWN ALL MEN BY THESE PRESENTS, that the Principal and Surety named above, who are
authorized to engage in business in the State of Oklahoma, are indebted to the STATE OF OKLAHOMA,
as Obligee in the penal sum indicated above, for the payment of which, well and truly to be made, we
bind ourselves, our heirs, executors, administrators, legal representatives, successors and assigns, jointly
and severally firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH THAT:
WHEREAS, the above named Principal has applied or intends to apply for a license as a Pharmacy
Benefits Manager pursuant to Title 59 O.S. § 358 and is required under the provisions of Title 59 O.S. §
358(B) to furnish a surety bond conditioned as herein set forth:
NOW THEREFORE, the Principal, his agents and employees shall: Conform with the laws, rules and
regulations governing Pharmacy Benefit Managers for the benefit of the parties protected by the
provisions of Title 59 O.S. §§ 357-360 with whom the Principal deals.
1
Bond No.:_________________
PHARMACY BENEFITS MANAGER’S BOND
OKLAHOMA INSURANCE DEPARTMENT
STATE OF OKLAHOMA
Name of Principal: _____________________________________________________________________
Address of Principal: ___________________________________________________________________
Name of Surety: _______________________________________________________________________
Address of Surety: ________________________________________________________________
State in which Surety is organized: ________________________________________________________
Number of Lives Covered: _________________________________________________________
Minimum Penal Sum: (mark the applicable amount)
____$50,000 (0-5,000 annual lives covered)
____$100,000 (5,001-10,000 annual lives covered)
____$250,000 (10,001 - 25,000 annual lives covered)
____$500,000 (25,001 – 50,000 annual lives covered)
____$750,000 (50,001 -100,000 annual lives covered)
____$1,000,000 (100,001 – Up annual lives covered)
Effective Date: ___________________________________.
KNOWN ALL MEN BY THESE PRESENTS, that the Principal and Surety named above, who are
authorized to engage in business in the State of Oklahoma, are indebted to the STATE OF OKLAHOMA,
as Obligee in the penal sum indicated above, for the payment of which, well and truly to be made, we
bind ourselves, our heirs, executors, administrators, legal representatives, successors and assigns, jointly
and severally firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH THAT:
WHEREAS, the above named Principal has applied or intends to apply for a license as a Pharmacy
Benefits Manager pursuant to Title 59 O.S. § 358 and is required under the provisions of Title 59 O.S. §
358(B) to furnish a surety bond conditioned as herein set forth:
NOW THEREFORE, the Principal, his agents and employees shall: Conform with the laws, rules and
regulations governing Pharmacy Benefit Managers for the benefit of the parties protected by the
provisions of Title 59 O.S. §§ 357-360 with whom the Principal deals.
1
NOW THEREFORE, the Surety does, by these presents, undertake and agree that the obligation of this
bond shall cover and extend to the liability of the Principal effective as of the date above and shall
continue in full force and effect until terminated or canceled, as provided herein.
The Parties further agree that:
Continuing Obligation: This bond is a continuing obligation and shall cover the full period or periods of
licensing of the Principal, as a Pharmacy Benefits Manager, including the present and all renewal licenses
which said Principal may be granted; provided, that it is hereby expressly agreed that nothing contained
herein shall be deemed or construed to reduce the liability of the Principal and Surety below the penal
sum set forth above for each and every licensing period for which the named Principal shall be licensed,
the same as if a new bond in the said penal sum were entered into for each and every separate period.
Duration of Bond: The bond shall be continuous in nature and shall remain in effect as long as the
Principal’s license, as Pharmacy Benefits Manager, remains in effect.
Termination: No party may cancel the bond without first giving thirty (30) days written notice to the
Principal and the Insurance Commissioner of the State of Oklahoma. The Surety may cancel this bond
and terminate its obligation hereunder at any time by giving thirty (30) days written notice by registered
mail to the Principal and the Insurance Commissioner of the State of Oklahoma. If the bond is terminated,
the Surety shall remain liable under the provisions of this bond for any liability already accrued under this
bond or which shall accrue before the expiration of the thirty day notice period.
Beneficiaries: This bond is for the benefit of the State of Oklahoma and any and all persons suffering
damages by reason of Principal’s failure to comply with Oklahoma Statutes or other legal obligations
arising out of Principal’s conduct as a Pharmacy Benefits Manager.
Right to Bring Action: If the Principal violates Title 59 O.S. §§ 357-360 or other legal obligations arising
out of its conduct as a Pharmacy Benefits Manager, the State of Oklahoma, as well as any person
damaged as a result of such violation shall have, in addition to all other legal remedies, a right of action
upon this bond for loss sustained by the injured party in any court having jurisdiction of the amount
claimed for the recovery of any loss sustained.
Notice: In the event either the Principal and/or the Surety under this bond are served with notice of any
action commenced or notice of intent to file an action or claim against said Principal or Surety under the
bond, said Principal and Surety shall, respectively, and within ten (10) days, give written notice of the
filing of such action or the intent to file an action or claim, as well as give written notice within ten (10)
days of the final disposition of such action or claim to, the following address:
Oklahoma Insurance Department
RIS Division
400 NE 50th St.
Oklahoma City, OK 73105
2
Modification: The Principal and the Surety agree that they shall not amend, modify or vary any term of
this bond without prior written consent of the Insurance Commissioner of the State of Oklahoma.
Warranties: The Surety hereby represents and warrants that it is in full compliance with the provisions of
the laws of the State of Oklahoma.
In addition to all other amounts payable hereunder, Surety shall reimburse Obligee for all costs and
expenses (including attorneys’ fees) that Obligee incurs in the enforcement of the provisions of this bond.
IN WITNESS WHEREOF, Principal and Surety have signed and sealed this surety bond as of the ___
day of ________________________________, 20____.
_____________________________________
_____________________________________
(Name of Principal)
(Name of Surety)
By: __________________________________
By: __________________________________
(Signature)
(Signature)
_____________________________________
_____________________________________
(Print Name)
(Print Name)
_____________________________________
_____________________________________
(Title)
(Title)
____________________________________
____________________________________
(Address)
(Address)
____________________________________
_____________________________________
(Address Continued)
(Address Continued)
____________________________________
(Attorney in Fact)
Notary Stamp
Subscribed to and sworn before me
______________________________________
(Date)
_____________________________________
(Signature of Notary Public)
____________________________________
(Commission Expiration Date)
3
Page of 3