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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 /> increases or decreases to the pricing of past claims. <br /> Any positive or negative differences in estimated or average pricing are accounted for <br /> through variance accounts maintained by the Host Blue and are incorporated into future <br /> claim prices. As a result, the amounts charged to Employer will be adjusted in a <br /> following year, as necessary, to account for over- or underestimation of the past years' <br /> prices. The Host Blue will not receive compensation from how the estimated price or <br /> average price methods, described above, are calculated. Because all amounts paid are <br /> final, neither positive variance account amounts (funds available to be paid in the <br /> following year), nor negative variance amounts (the funds needed to be received in the <br /> following year), are due to or from Employer. If Employer terminates, you will not <br /> receive a refund or charge from the variance account. <br /> Variance account balances are small amounts relative to the overall paid claims <br /> amounts and will be liquidated over time. The timeframe for their liquidation depends on <br /> variables, including, but not limited to, overall volume/number of claims processed and <br /> variance account balance. Variance account balances may earn interest at the federal <br /> funds or similar rate. Host Blues may retain interest earned on funds held in variance <br /> accounts. <br /> 3. BlueCard Program Fees and Compensation <br /> Employer understands and agrees to reimburse Florida Blue for certain fees and <br /> compensation which Florida Blue is obligated under the BI ueCard Program to pay to the <br /> Host Blues, to the Association and/or to vendors of BlueCard Program related services. <br /> The specific BlueCard Program fees and compensation that are charged to Employer <br /> are set forth in Exhibit B. BlueCard Program Fees and compensation may be revised <br /> from time to time. <br /> Only the BlueCard Program access fee may be charged separately each time a claim is <br /> processed through the BI ueCard Program. All other BlueCard Program related fees are <br /> included in the Administrative Fee. <br /> The access fee is charged by the Host Blue to Florida Blue for making its applicable <br /> provider network available to Employer's. The access fee will not apply to non- <br /> participating provider claims. The access fee is charged on a per claim basis and is <br /> charged as a percentage of the discount/differential Florida Blue receives from the <br /> applicable Host Blue subject to a maximum of$2,000 per claim. When charged, Florida <br /> Blue passes the access fee directly on to Employer. <br /> Instances may occur in which the claim payment is zero or Florida Blue pays only a <br /> small amount because the am ounts eligible for payment were applied to pati ent cost <br /> sharing (such as a deductible or coinsurance). In these instances, Florida Blue will pay <br /> the Host Blue's access fee and pass it along directly to Employer as stated above even <br /> Employer paid little or had no claim liability. <br /> An Administrative Fee encompasses fees Florida Blue charges to Employer for <br /> administering Employer's benefit plan. They may include both local (within Florida <br /> Blue's service area) and Inter-Plan fees. For purposes of this Agreement, they include <br /> the following BlueCard Program related fees other than the BI ueCard Program access <br /> fee: namely, administrative expense allowance (AEA) fee, central financial agency fee, <br /> 20160629 3 <br />
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