2023-098B - Laserfiche WebLink

Home Browse Search

Subrogation Services (Threshold $1,000) 30% of recovered amount Access fees of up to 2.02% of Network Savings for PPO provider claims and 3.79% of Network savings for Traditional provider claims may be assessed for claims incurred in states under the B1ueCard program as explained in more detail under Section XII below. This access fee will not exceed two thousand dollars ($2,000) for any one claim and will not apply in Florida, South Carolina or in Consortium Plan Service Areas which is the geographic area where enrolled members reside as long as enrollment continues to be equal to or greater than one thousand (1,000) contracts. On the first anniversary date after enrollment falls below one thousand (1,000) contracts, access fees will apply in those Consortium Plan service areas where enrolled members reside and Consortium fees were not previously established. Access fees will also apply in Consortium Plan service areas where no enrolled members reside. A determination of the Consortium Plan service areas that will not apply access fees for services rendered to members will be made on the basis of enrollment on each subsequent anniversary of this Agreement's Effective Date. Access fees will be applied on the basis of where the service was incurred, and not where the member resides. Network Savings is defined as the total of the amounts computed by subtracting each "allowed amount" for a particular service under the terms of a participating provider's written agreement from each "billed amount" for such service. In no event shall the term "Network Savings" include duplicate charges or billed amounts for services or supplies not covered under the Employer's Plan. The term "allowed amount" means the amount received as payment in full by a participating provider, under that provider's written agreement, from both BCBSF and covered individuals under Employer's Plan for claims submitted to, and paid by BCBSF for a particular covered service, and the term "billed amount" means the amount which would be received by such provider for the same covered service utilizing that provider's charges. The Allowed Amount for Emergency Services provided by Non -Participating or Non -Contracting Providers will pay in accordance with the definition of Maximum Payment in the Plan of Benefits. C. The base Administrative Fee is guaranteed through 9/30/2026, however, BCBSF may: (1) Revise the base Administrative Fee, upon thirty (30) days' notice prior to the first anniversary of the Effective Date; (2) Revise the base Administrative Fee, at any time, if any change in law or regulation or interpretation of law or regulation by Federal, State or Local governmental agency or entity imposes greater material duties, obligations or costs on the Designated Agent and/or BCBSF than contemplated by this Agreement; In addition, the Employer shall assume the liability for any tax, assessment or cost based upon the existence of the Employer's Plan, including all fines, penalties, losses, damages, costs, expenses, attorneys' fees and court costs incurred in connection with any assessment. Furthermore, if BCBSF shall pay, pursuant to the demand of an appropriate official of any state, any tax, assessments or costs based on the amounts paid into or from the Plan, the Employer shall reimburse BCBSF, upon demand, the full amount of such taxes, assessments or costs paid together with the additional amounts specified in connection with such assessment, including any 26