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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)
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\Official Documents\2020's\2025
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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />EXHIBIT B <br />Financial Arrangement <br />Administrative Fees term: October 1, 2025 — September 30, 2029 <br />II. While this Agreement is in effect, Services will be furnished in connection with the Plan <br />including claims processing and payments of the amount due with respect to claims <br />incurred on or after the Effective Date that qualify under the Plan. Employer will fully <br />reimburse Designated Agent for the payment of claims as specified in this Exhibit. <br />III. The Administrative Fees applicable to this Agreement include a base administrative <br />fee and administrative charges for other fees and services as described in Sections A <br />and B directly below. <br />A. The base administrative fees are as follows for the Plan. <br />October 1, 2025 through September 30, 2028: $48.14 PEPM <br />October 1, 2028 through September 30, 2029: $49.58 PEPM <br />B. In addition to the base administrative fee, the administrative charges for other fees <br />and services are stated below. <br />Such charges are subject to change for subsequent benefit years. <br />Radiology Management (Evolent fka NIA) <br />Included in Administrative Fee <br />Stop -Loss Coordination <br />Included in Administrative Fee <br />Packets to von -Blue Stop -Loss vendors <br />Teladoc General Medical (Claims costs also <br />Included in Administrative Fee <br />apply) <br />Pharmacy: Integrated Real -Time <br />Included in Administrative Fee <br />Deductible and <br />Maximum Out -of -Pocket Processing for <br />Carved Out PBM <br />One time Wellness Contribution upon <br />$50,000 <br />Board approval <br />Additional Annual Wellness Contributions <br />$503000 <br />(10/01/2025,10/01/2026,10/01/2027 and <br />10/01/2028) as long as coverage remains in <br />effect. <br />Access fees of up to 1.84% of Network Savings for PPO provider claims and 3.31 % <br />of Network savings for Traditional provider claims may be assessed for claims <br />incurred in states under the BlueCard program as explained in more detail under <br />Section XIII below. This access fee will not exceed two thousand dollars ($2,000) <br />for any one claim and will not apply in Florida, South Carolina or in Consortium <br />Plan Service Areas which is the geographic area where enrolled Members reside <br />
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