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2025-125
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2025-125
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Last modified
6/23/2025 10:25:09 AM
Creation date
6/23/2025 10:16:29 AM
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Template:
Official Documents
Official Document Type
Amendment
Approved Date
06/03/2025
Control Number
2025-125
Agenda Item Number
13.D.1.
Entity Name
Blue Cross and Blue Shield of Florida, Inc.
Subject
Amendment No. 1 to Administrative Services Agreement
Document Relationships
2025-126
(Cover Page)
Path:
\Official Documents\2020's\2025
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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />Value -Based Programs incentives/Shared Savings settlements to accounts are <br />outside of the claim system. BCBSF and/or its Designated Agent will pass <br />these Host Blue charges directly through to Employer as a separately identified <br />amount on the group billings; or, <br />(ii) Where Host Blues pass on the costs of Value -Based Programs to BCBSF <br />and/or its Designated Agent as PMPM amounts not attached to specific claims, <br />BCBSF and/or its Designated Agent may elect to pass these amounts to <br />Employer as a claim amount. <br />The amounts used to calculate either the supplemental factors for estimated <br />pricing or PMPM billings are fixed amounts that are estimated to be necessary to <br />finance the cost of a particular Value -Based Program. Because amounts are <br />estimates, there may be positive or negative differences based on actual <br />experience, and such differences will be accounted for in a variance account <br />maintained by the Host Blue (in the same manner as described in the BlueCard <br />claim pricing section above) until the end of the applicable Value -Based Program <br />payment and/or reconciliation measurement period. The amounts needed to fund <br />a Value -Based Program may be changed before the end of the measurement <br />period if it is determined that amounts being collected are projected to exceed the <br />amount necessary to fund the program or if they are projected to be insufficient to <br />fund the program. <br />At the end of the Value -Based Program payment and/or reconciliation <br />measurement period for these arrangements, Host Blues will take one of the <br />following actions: <br />• Use any surplus in funds in the variance account to fund Value -Based <br />Program payments or reconciliation amounts in the next measurement <br />period. <br />• Address any deficit in funds in the variance account through an adjustment <br />to 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, <br />average or PMPM price methods, described above, are calculated. If Employer <br />terminates, you will not receive a refund or charge from the variance account. This <br />is because any resulting surpluses or deficits would be eventually exhausted <br />through prospective adjustment to the settlement billings in the case of Value - <br />Based Programs. The measurement period for determining these surpluses or <br />deficits may differ from the term of this Agreement. <br />Variance account balances are small amounts relative to the overall paid claims <br />amounts and will be liquidated over time. The timeframe for their liquidation <br />depends on variables, including, but not limited to, overall volume/number of <br />claims processed and variance account balance. Variance account balances may <br />earn interest, and interest is earned at the federal funds or similar rate. Host Blues <br />13 <br />
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