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2023-098B
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2023-098B
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Last modified
3/18/2024 12:03:39 PM
Creation date
3/18/2024 11:53:00 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
05/16/2023
Control Number
2023-098B
Agenda Item Number
12.D.2.
Entity Name
Blue Cross and Blue Shield
Subject
Shield Transition Health Plan Administrative Services from
Blue Cross Shield of Florida Inc.(Florida Blue)
to Blue Cross Blue Shield National Alliance effective 10/01/2023 thru 9/30/2026
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information (eg. employment status or a change in coverage). It is the Employer's <br />responsibility to ensure any retroactive member termination forwarded to BCBSF is in <br />compliance with federal law, specifically, that such termination was due to either a member's: <br />(i) fraudulent act, practice or omission; (ii) intentional misrepresentation of material fact, or <br />(iii) failure to timely pay required premiums or contributions towards the cost of coverage. <br />The Employer is solely responsible for providing to the member any notice related to <br />retroactive terminations or rescissions that are required by law. In the event of retroactive <br />termination of members, BCBSF shall not be responsible for denials of claims under <br />Employer's Stop Loss Insurance. If Stop -Loss Insurance is not provided by BCBSF or a <br />BCBSF affiliate, Employer will provide BCBSF with a copy of the Stop -Loss Insurance policy. <br />Employer will notify BCBSF as soon as possible of any change related to Stop -Loss Insurance. <br />Employer is responsible for all eligibility determinations related to Stop Loss Insurance. <br />Employer shall provide information necessary for BCBSF to process claims and provide all <br />information to the Stop -Loss carrier in order for the Stop -Loss carrier to make a determination <br />on the claims submitted. <br />K. Confidential and Trade Secret Information. <br />BCBSF maintains proprietary and confidential information and competitively sensitive trade <br />secret information, which information may be disclosed to Employer for the purposes of <br />analyzing such information in conjunction with the services performed under the Agreement. <br />Employer agrees to hold such confidential and/or trade secret information in confidence and <br />only disclose such information to employees of Employer who have a need to know such <br />information; provided however that such employees of Employer agree to maintain the <br />confidentiality of the confidential and/or trade secret information and take all steps necessary <br />to safeguard the confidential and/or trade secret information against unauthorized access, use, <br />and disclosure to at least the extent Employer maintains the confidentiality of its most <br />proprietary and confidential information. <br />Except as required by law, Employer shall not disclose such confidential and/or trade secret <br />information to any third party without the express written permission of BCBSF. If BCBSF, <br />in its sole discretion, approves release of confidential and/or trade secret information to a third <br />party, the third party and Employer will be required to execute a Confidentiality & Indemnity <br />Agreement, in a form specified by BCBSF, prior to the release of the confidential information <br />and/or trade secret information to the third party. Comingling means the combination of data <br />sets from multiple sources, including but not limited to the combination of Inter -Plan Data and <br />or Association data with non-InterPlan Data and/or non -Association data. Employer may not <br />Comingle Inter -Plan Data to the extent otherwise permitted in this Agreement, provided that, <br />to the extent Employer comingles the Inter -Plan Data with data from other Licensees or non - <br />Licensee group accounts or individual members, the data must be de -coupled and returned or <br />destroyed upon termination of this Agreement. <br />Blinding means the process of removing or masking data in a manner that it cannot be re- <br />populated by the recipient. Although Employer may Blind Blue Information and/or Inter -Plan <br />Data and/or prepare reports containing Blue Information and/or Inter -Plan Data, Employer <br />may not alter Blue Information or Inter -Plan Data in any manner. Employer may not Comingle <br />Inter -Plan Data to the extent otherwise permitted in this Agreement, provided that, to the extent <br />Employer Comingles the Inter -Plan Data with data from other Licensees or non -Licensee <br />group accounts or individual members, the data must be de -coupled and returned or destroyed <br />upon termination of this Agreement. Inter -Plan Data is information that relates to another <br />4 <br />
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