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2018-105B
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Last modified
12/30/2020 11:55:59 AM
Creation date
10/8/2018 12:49:27 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
06/05/2018
Control Number
2018-105B
Agenda Item Number
12.D.1.
Entity Name
Blue Cross and Blue Shield of Florida
Subject
Wellness Contribution
Area
Amendment to Administrative Services Agreement
Alternate Name
Florida Blue
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$51.50 per enrolled employee per month from October 1, 2019 <br />through September 30, 2021. <br />$53.05 per enrolled employee per month from October 1, 2021 <br />through September 30, 2023. <br />B. Florida Blue will pay Employer a $50,000 wellness contribution, on October <br />1, 2018 upon the Board's approval of renewing this Agreement, and $50,000 <br />per year, each year for five years upon renewing this Agreement for any <br />wellness related initiatives or activities. <br />C. Administrative fees after the termination of the Agreement: 15% of claims <br />paid. <br />D. Access fees of up to 2.40% of Network Savings for PPO provider claims and <br />4.51 % of Network savings for Traditional provider claims may be assessed <br />for claims incurred in states under the BlueCard program as explained in <br />more detail under Section III, subsection 3.9 below. This access fee will not <br />exceed two thousand dollars ($2,000) for any one claim and will not apply in <br />Florida, South Carolina or in Consortium Plan service areas where enrolled <br />members reside as long as enrollment continues to be equal to or greater <br />than one thousand (1,000) contracts. On the first anniversary date after <br />enrollment falls below one thousand (1,000) contracts, access fees will apply <br />in those Consortium Plan service areas where enrolled members reside and <br />Consortium fees were not previously established. Access fees will also apply <br />in Consortium Plan service areas where no enrolled members reside. A <br />determination of the Consortium Plan service areas that will not apply access <br />fees for services rendered to members will be made on the basis on <br />enrollment on each subsequent anniversary of this Agreement's effective <br />date. Access fees will be applied on the basis of where the service was <br />incurred, and not where the member resides. <br />Network Savings is defined as the total of the amounts computed by <br />subtracting each "allowed amount" for a particular service under the terms <br />of a participating provider's written agreement from each "billed amount" for <br />such service. In no event shall the term "Network Savings" include <br />duplicate charges or billed amounts for services or supplies not covered <br />under the Employer's Plan. The term "allowed amount" means the amount <br />received as payment in full by a participating provider, under that provider's <br />written agreement, from both Florida Blue and covered individuals under <br />Employer's Plan for claims submitted to, and paid by Florida Blue for a <br />particular covered service, and the term "billed amount" means the amount <br />which would be received by such provider for the same covered service <br />utilizing that provider's charges. <br />-2- <br />
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