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Value -Based Programs incentives/Shared Savings settlements to accounts are <br />outside of the claim system. BCBSF and/or its Designated Agent will pass these <br />Host Blue charges directly through to Employer as a separately identified amount <br />on the group billings; or, <br />Where Host Blues pass on the costs of Value -Based Programs to BCBSF and/or its <br />Designated Agent as PMPM amounts not attached to specific claims, BCBSF <br />and/or its Designated Agent may elect to pass these amounts to Employer as a claim <br />amount. <br />The amounts used to calculate either the supplemental factors for estimated pricing or <br />PMPM billings are fixed amounts that are estimated to be necessary to finance the cost <br />of a particular Value -Based Program. Because amounts are estimates, there may be <br />positive or negative differences based on actual experience, and such differences will be <br />accounted for in a variance account maintained by the Host Blue (in the same manner as <br />described in the BlueCard claim pricing section above) until the end of the applicable <br />Value -Based Program payment and/or reconciliation measurement period. The amounts <br />needed to fund a Value -Based Program may be changed before the end of the <br />measurement period if it is determined that amounts being collected are projected to <br />exceed the amount necessary to fund the program or if they are projected to be <br />insufficient to fund the program. <br />At the end of the Value -Based Program payment and/or reconciliation measurement <br />period for these arrangements, Host Blues will take one of the following actions: <br />Use any surplus in funds in the variance account to fund Value -Based Program <br />payments or reconciliation amounts in the next measurement period. <br />• Address any deficit in funds in the variance account through an adjustment to <br />the PMPM billing amount or the reconciliation billing amount for the next <br />measurement period. <br />The Host Blue will not receive compensation resulting from how estimated, average or <br />PMPM price methods, described above, are calculated. If Employer terminates, you will <br />not receive a refund or charge from the variance account. This is because any resulting <br />surpluses or deficits would be eventually exhausted through prospective adjustment to the <br />settlement billings in the case of Value -Based Programs. The measurement period for <br />determining these surpluses or deficits may differ from the term of this Agreement. <br />Variance account balances are small amounts relative to the overall paid claims amounts <br />and will be liquidated over time. The timeframe for their liquidation depends on variables, <br />including, but not limited to, overall volume/number of claims processed and variance <br />account balance. Variance account balances may earn interest, and interest is earned at <br />the federal funds or similar rate. Host Blues may retain interest earned on funds held in <br />variance accounts. <br />Note: Members will not bear any portion of the cost of Value -Based Programs except <br />when a Host Blue uses either average pricing or actual pricing to pay providers under <br />Value -Based Programs. <br />Care Coordinator Fees <br />33 <br />