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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 />VII. There will be no interest accrued or payable by BCBSF on any funds held pursuant to <br />this Agreement. However, during the term of this Agreement, should the Employer not <br />make payment in accordance with the provisions of this Exhibit, amounts due shall be <br />subject to a late charge of 1.0% per month. The late charge shall be billed separately <br />to the Employer. The Employer warrants and agrees that the late charge will be paid <br />solely from Employer's funds and not from the funds of any employee welfare plan or <br />trust. <br />VIII. Claim Processing: BCBSF will, process claims incurred and timely submitted on or <br />after the Effective Date. The claim must be received within ninety (90) days after the <br />beginning of care or, if by a participating provider, within the filing period permitted <br />under the participating provider's contract, however, failure to file the claim within such <br />period will not prevent payment of benefits if the member shows that it was not <br />reasonably possible to timely file the claim, provided the claim is filed as soon as is <br />reasonably possible, in no event, except in the absence of legal capacity, no later than <br />twelve (12) months from the date services were rendered. Claims will be adjudicated <br />in the order received and will not be re -adjudicated due to out of sequence dates of <br />services. <br />Employer understands and acknowledges that BCBSF may deny any claims that are <br />processed while any amount is past due or delinquent under this Agreement. <br />IX. In the event of default in reimbursements directly to BCBSF and/or its Designated <br />Agent as required under the terms of this Agreement, and if such default remains <br />uncured for a period of thirty (30) days after written notice of such default is provided <br />to Employer, BCBSF shall have the right to terminate the Agreement. Such right to <br />terminate shall be in addition and not limitation of any right to terminate under the <br />other provisions of this Agreement. <br />X. Stop -Loss Insurance, the insurance procured by Employer that insures Employer <br />against claims made in excess of certain amounts, shall be provided in conformity with <br />the terms of the separate agreement with BCBSF and paid by the Employer as the <br />Plan Administrator as applicable. <br />Employer will make payments to BCBSF required under this Agreement (regardless <br />of any Stop -Loss Insurance coverage Employer obtained from a carrier other than <br />BCBSF) that may cover such claims and regardless of the existence of any pending <br />Stop -Loss Insurance reimbursement that has not been paid to Employer. <br />XI. Employer has separately contracted with a Pharmacy Benefit Manager for pharmacy <br />management services (the "PBM Vendor"). BCBSF shall be entitled to rely on any <br />information provided to it by Employer's PBM Vendor. BCBSF shall base certain <br />eligibility coverage and other determinations in the performance of its responsibilities <br />under this Agreement in reliance on the information so provided; and shall not be <br />required to confirm or verify the accuracy, authenticity or completeness of any <br />information so provided. BCBSF shall not be liable for any damages that may result <br />from its reliance on and/or utilization of inaccurate or incomplete information received <br />from Employer's PBM Vendor. <br />
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