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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
Metadata
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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 />The Member may be responsible for the difference between the amount that <br />the nonparticipating healthcare provider bills and the payment BCBSF and/or <br />its Designated Agent will make for the covered services as set forth in this <br />paragraph. <br />2. Fees and Compensation <br />Employer understands and agrees to reimburse BCBSF and/or its Designated <br />Agent for certain fees and compensation which we are obligated under applicable <br />Inter -Plan Arrangement requirements to pay to the Host Blues, to the Association <br />and/or to vendors of Inter -Plan Arrangement related services. The specific fees <br />and compensation that are charged to Employer are set forth in this Exhibit B, if <br />applicable. Fees and compensation under applicable Inter -Plan Arrangements <br />may be revised from time to time. <br />G. Blue Cross Blue Shield Global® Core <br />1. General Information <br />If Members are outside the United States, (the Commonwealth of Puerto Rico and <br />the U.S. Virgin Islands) (hereinafter: "BlueCard service area"), they may be able to <br />take advantage of the Blue Cross Blue Shield Global® Core when accessing <br />covered healthcare services. The Blue Cross Blue Shield Global® Core is unlike <br />the BlueCard Program available in the BlueCard service area in certain ways. For <br />instance, although the Blue Cross Blue Shield Global® Core assists Members with <br />accessing a network of inpatient, outpatient and professional providers, the <br />network is not served by a Host Blue. As such, when Members receive care from <br />providers outside the BlueCard service area, the Members will typically have to <br />pay the providers and submit the claims themselves to obtain reimbursement for <br />these services. <br />Inpatient Services - In most cases, if Members contact the Blue Cross Blue <br />Shield Global® Core Service Center for assistance, hospitals will not require <br />Members to pay for covered inpatient services, except for their cost -share <br />amounts. In such cases, the hospital will submit Member claims to the Blue <br />Cross Blue Shield Global® Core Service Center to initiate claims processing. <br />However, if the Member paid in full at the time of service, the Member must <br />submit a claim to obtain reimbursement for covered healthcare services. <br />Members must contact BCBSF and/or its Designated Agent to obtain <br />precertification for non -emergency inpatient services. <br />Outpatient Services - Physicians, urgent care centers and other outpatient <br />providers located outside the BlueCard service area will typically require <br />Members to pay in full at the time of service. Members must submit a claim to <br />obtain reimbursement for covered healthcare services. <br />• Submitting a Blue Cross Blue Shield Global® Core Claim <br />When Members pay for covered healthcare services outside the BlueCard <br />16 <br />
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