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E 40 171 When the Administrator is charged apt access fee, the Administrator will pass the charge along to the Employer as a claims expense. If the Administrator receives an access fee credit, the Administrator will give the Employer a claims expense credit. Access fees are considered a claims expense because they represent claim dollars the Administrator was unable to, or in the case of a credit was able to, avoid, Instances may occur in which the Administrator sloes not pay a claim (or pays only a small amount) because the amounts eligible for payment were applied to the Deductible, Coinsurance or Copayment. In such instances the Host Plan's arrangement with its Provider may allow the negotiated payment rate to apply when the anio unt is fully or mostly a patient obligation. If so, the Administrator will pay the Host Plan's access fee and pass it along to the Employer as a claims expense even though the Administrator paid little or none of the claim. 'Hie negotiated rate paid by the Administrator to the Host Plan under the B1ueCard Program for health care services will be arrived at using one of the following three options. The first option rases the actual price paid on the claim. In limited circumstances this price may be greater than charges (e.g. sometimes payment under a DRG payment system will be treater than charges). The second option uses an estimated price. This price reflects an adjusted aggregate payment expected to result from past or future settlements or other non -claims transactions with all of the Host Plan's Health Care Providers or one or more particular Providers. The third option uses a discount from billed charges. This price is obtained by applying an average savings factor representing the Host Plan's expected savings for all of its Providers or for a specific group of Providers. Estimated and average pricing used under options two and three may be prospectively adjusted. This helps correct for either over or under estimation of past prices. Additionally, the following charges will be paid for each claim processed under the B1ucCard Program as an administrative fee under this Agreement, inpatient Claims - $11; outpatient claims - $11; and professional claims - $5, these charges being subject to change without further notification to the Employer. The calculation of Coinsurance and other member liability for Covered Services will be at the lower of the Provider's billed charges or the negotiated rate the Administrator pays the Host Plan under the BlueCard Program. Also note that statutes in a small number of states require local Blue Cross and/or Blue Shield Plans to use a basis for calculating member liability for Covered Services that does not reflect the entire savings realized or expected to be realized on a