2000-270A - Laserfiche WebLink

Home Browse Search

i 40 L I r®v �of Flo races iihie5lrteld of Florida Ileallh Options. r JL., 6-0 // F �yy0-�)y C.0 AIVIENIIMEN'I' TO ADMINISTRATIVE SERVICES AGREEMENT effective THIS AMENDMENT, -rata on October 1, 1997 is by and between Blue Cross and Blue Shield of Florida, Inc. (hereinafter called the "Administrator") and Indian Diver County (hereinafter called the "Employer"). In consideration of the mutual and reciprocal promises herein contained, the Administrative Services Agreement between the Administrator and the Employer (hereinafter "Agreement") is amended as follows; 40075.10OR Ps I. The following provision is hereby amended to read as follows: Providers Outside the State of Florida When amounts are paid or payable by the Administrator to Providers of service outside the State of Florida under this Agreement and the Group Health Plan, reimbursement to the out-of-state Provider may be determined based on the Provider arrangements, if any, the Blue Cross and/or Blue Shield Plan in the area where services are provided has with its Provider. Also, the member's financial responsibilities (e.g. coinsurance requirement limits) may be determined using the same Provider arrangements. in those instances the Blue Cross and/or Blue Shield Plan in that area is called a "Host Plan". The Administrator will coordinate with the appropriate Host Plan when reimbursement and financial responsibilities are to be so handled. This is done by use of a special national program called the B1ueCard Program. Participation in this program allows the Administrator to make available out -of --area services at rates that would generally not be available had the Administrator paid the Provider directly. Under the BlueCard Program, Hast Plans may charge the Administrator a fee (called an access fee) for making their negotiated payment rates available on claims incurred. The access fee may be up to 10 percent (but not to exceed $2,000 for any claim) of the discount the Host Plan has obtained from its Providers. The total amount paid by the Administrator to such other plans shall be considered the amount of the claim under this Agreement and shall be the financial responsibility of the Employer. The access fee may be charged only if the Host Plan's arrangement with the Provider prohibits billing Members for amounts in excess of the negotiated payment rate. However, Providers may bill for Deductibles, Coinsurance and/or Copayments.