3/27/2018 3:17:35 PM
8/30/2017 4:19:51 PM
Official Document Type
Agenda Item Number
Blue Cross and Blue Shield of Florida
Administrative Services Agreement
Group Health Plan
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• <br />BlueCross BlueShield <br />of Florida <br />Health Options. <br />YWywde lWoven al Os <br />OW Caws s a d p Mwdllrwwen <br />o©- 0270 <br />AMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT <br />effective <br />THIS AMENDMENT, -entered-into on October 1. 1997 is by and between Blue Cross and <br />Blue Shield of Florida, Inc. (hereinafter called the "Administrator") and Indian River <br />County (hereinafter called the "Employer"). In consideration of the mutual and reciprocal <br />promises herein contained, the Administrative Services Agreement between the <br />Administrator and the Employer (hereinafter "Agreement") is amended as follows: <br />1. The following provision is hereby amended to read as follows: <br />Providers Outside the State of Florida <br />When amounts are paid or payable by the Administrator to Providers of service <br />outside the State of Florida under this Agreement and the Group Health Plan, <br />reimbursement to the out-of-state Provider may be determined based on the <br />Provider arrangements, if any, the Blue Cross and/or Blue Shield Plan in the area <br />where services are provided has with its Provider. Also, the member's financial <br />responsibilities (e.g. coinsurance requirement limits) may be determined using the <br />same Provider arrangements. In those instances the Blue Cross and/or Blue Shield <br />Plan in that area is called a "Host Plan". The Administrator will coordinate with <br />the appropriate Host Plan when reimbursement and financial responsibilities are <br />to be so handled. This is done by use of a special national program called the <br />BlueCard Program. Participation in this program allows the Administrator to <br />make available out -of -area services at rates that would generally not be available <br />had the Administrator paid the Provider directly. <br />Under the BlueCard Program, Host Plans may charge the Administrator a fee <br />(called an access fee) for making their negotiated payment rates available on <br />claims incurred. The access fee may be up to 10 percent (but not to exceed <br />$2,000 for any claim) of the discount the Host Plan has obtained from its <br />Providers. The total amount paid by the Administrator to such other plans shall <br />be considered the amount of the claim under this Agreement and shall be the <br />financial responsibility of the Employer. The access fee may be charged only if <br />the Host Plan's arrangement with the Provider prohibits billing Members for <br />amounts in excess of the negotiated payment rate. However, Providers may bill <br />for Deductibles, Coinsurance and/or Copayments. <br />40035-100R PS <br />II <br />
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