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2016-199
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Last modified
12/7/2016 1:25:50 PM
Creation date
12/7/2016 1:25:49 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Amendment
Approved Date
12/06/2016
Control Number
2016-199
Agenda Item Number
8.D.
Entity Name
Blue Cross and Blue Shield of Florida Inc.
Subject
Amendment to Adminstrative Services Agreement
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A TRUE COPY <br /> CERTIFICATION ON LAST PAGE <br /> J.R. SMITH, CLERK <br /> AMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT <br /> This Amendment, which is effective January 1, 2017, is by and between Blue Cross and Blue <br /> Shield of Florida, Inc. (hereinafter referred to as "Florida Blue") and Indian River County Board of <br /> County Commissioners (hereinafter referred to as "Employer"). In consideration of the mutual and <br /> reciprocal promises herein contained, the Administrative Services Agreement between Florida Blue <br /> and Employer (hereinafter"Agreement") is amended as follows: <br /> 1. The subsection entitled "Claims Processing" in Section III, Duties and Responsibilities of Florida <br /> Blue, is hereby amended by adding the following: <br /> For value-based reimbursement programs Florida Blue enters into with participating providers, <br /> an applicable per member per month charge may be included in lieu of a claim level surcharge. <br /> 2. The subsection entitled "Providers Outsi de the State of Florida", under Section III, Duties and <br /> Responsibilities of Florida Blue is hereby deleted in its entirety and replaced with the following: <br /> A. Inter-Plan Arrangements <br /> Florida Blue has a variety of relationships with other Blue Cross and/or Blue Shield <br /> Licensees referred to generally as "Inter-Plan Arrangements." These Inter-Plan <br /> Arrangements operate under rules and procedures issued by the Blue Cross Blue Shield <br /> Association ("Association"). Whenever members access healthcare services outside the <br /> geographic area Florida Blue serves, the claim for those services may be processed through <br /> one of these Inter-Plan Arrangements. The Inter-Plan Arrangements are described generally <br /> below. <br /> Typically, when accessing care outside the geographic area Florida Blue serves, members <br /> obtain care from healthcare providers that have a contractual agreement ("participating <br /> providers") with the local Blue Cross and/or Blue Shield Licensee in that other geographic <br /> area ("Host Blue"). In some instances, members may obtain care from healthcare providers <br /> in the Host Blue geographic area that do not have a contractual agreem ent ("nonparticipating <br /> providers") with the Host Blue. Florida Blue remains responsible for fulfilling our contractual <br /> obligations to Employer. Florida Blue payment practices in both instances are described <br /> below. <br /> This disclosure describes how claims are administered for Inter-Plan Arrangements and the <br /> fees that are charged in connection with Inter-Plan Arrangements. (Note that Dental Care <br /> Benefits, except when not paid as medical claims/benefits, and those Prescription Drug <br /> Benefits or Vision Care Benefits that may be administered by a third party contracted by <br /> Florida Blue to provide the specific service or services are not processed through Inter-Plan <br /> Arrangements.) <br /> B. BlueCard® Program <br /> The BlueCard® Program is an Inter-Plan Arrangement. Under this Arrangement, when <br /> members access covered healthcare services within the geographic area served by a Host <br /> Blue, the Host Blue will be responsible for contracting and handling all interactions with its <br /> participating healthcare providers. The financial terms of the BlueCard Program are described <br /> generally below. <br /> 1 Liability Calculation Method Per Claim — In General <br /> 20160629 1 <br />
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