2023-098B - Laserfiche WebLink

Home Browse Search

(and advising BCBSF of any necessary revisions) and (iii) distributing the Plan of Benefits to members. (15) Web Portal: BCBSF shall provide maintenance of a Web site providing Plan information for employees and their dependents including information on providers participating in the preferred provider organization networks. (16) Consultation Services: BCBSF shall provide consultation services to Employer on benefit plan development and overall Plan administration. (17) Reporting: a. Upon request of the Employer and receipt of any required information, BCBSF will prepare a report of the cost of any proposed modification or extension of the Employer's Plan. In connection therewith, BCBSF will notify the Employer of any changes in Exhibit B under this Agreement which would be required if the Plan under the Agreement were so modified or extended. b. Upon request of the Employer, BCBSF will prepare the following standard reports: 1. An analysis of Benefit costs for the immediately preceding term of the Agreement, 2. Annual data required for federal disclosure reporting. 3. Each of BCBSF's "standard" quarterly reports that Employer requests. c. Additional reports may be available upon Employer's reasonable request for an additional fee and Employer shall reimburse BCBSF for any and all costs (including internal and out of pocket costs) incurred by BCBSF in providing any non-standard data and reports not expressly included under this Section II. (18) Payment of Benefits: If BCBSF or its Designated Agent determines that benefits are payable, but the provider does not participate in the participating or contracting provider network, BCBSF or its Designated Agent may (in BCBSF's or its Designated Agent's sole discretion, or as required by law) make payment to the member or to the provider. No one may assign a member's right to the payment of benefits without BCBSF's or its Designated Agent's express written consent (19) Consolidated Appropriations Act (CAA) Rx Reporting Requirements - On an annual basis, BCBSF will submit prescription drug and health care spending (RxDC) reports required under the CAA on behalf of Employer, at no cost, for reportable items and services administered by BCBSF. Employer must notify BCBSF in writing, by no later than 30 days from the initial group outreach following the reference year at issue if and to the extent that Employer contracts with or otherwise utilizes a third party to complete such reporting. If Employer provides, or arranges for a third party to provide, BCBSF with data for items and services that are not administered by BCBSF (such as pharmacy data for coverage that is administered or insured by a third -party pharmacy benefits manager), and requests that BCBSF include such data in its reporting for Employer, Employer shall be solely liable for the accuracy and completeness of such data. For RxDC reports required under the CAA, by no later than 30 days from the initial group outreach following the reference year at issue Employer will supply BCBSF with any 12