HomeMy WebLinkAbout2013-060 q /13 A TRUE COPY
/ CERTIFICATION ON LAST PAGE
J . R . SMITH , CLERK
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AMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT
THIS AMENDMENT , entered into on March 19 , 2013 is by and between Blue Cross
and Blue Shield of Florida , Inc. d/b/a Florida Blue ( hereinafter called " Florida Blue") and
Indian River County Board of County Commissioners (hereinafter called the " Employer") . In
consideration of the mutual and reciprocal promises herein contained , the Administrative
Services Agreement between Florida Blue and the Employer (hereinafter "Agreement')
effective October 1 , 1996 is amended as follows :
1 . Section I , subsection 1 . 1 , is hereby amended to extend the term of the Agreement
until September 30 , 2015 unless the Agreement is terminated earlier in accordance
with the terms of the Agreement.
2 . Exhibit B to the Agreement is hereby amended, effective May 11 2013 . The revised
Exhibit B is attached to this Amendment and replaces the Exhibit B previously
attached to the Agreement.
3 . Except as otherwise specifically noted in this Amendment, all other terms and
conditions of the Agreement shall remain unchanged and in full force and effect .
IN WITNESS WHEREOF , this Amendment has been executed by the duly
authorized representatives of the parties .
BLUE CROSS AND BLUE SHIELD INDIAN RIVER COUNTY BOARD OF
OF FLORIDA, INC . D/B/A FLORIDA COUNTY COMMISSIONERS
BLUE
By : By :
q Joseph E . Flescher
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Title : °°�*A Ie : Chai rman
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Date : a c pagam March 19 , 2013
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APPROVED AS TO FORM
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BY
ALPIN S. POLACKWICH
COUNTY ATTORNEY
A TRUE COPY
CERTIFICATION ON LAST PAGE
J . R . SMITH , CLERK
EXHIBIT " B"
to the
ADMINISTRATIVE SERVICES AGREEMENT
between
BLUE CROSS AND BLUE SHIELD OF FLORIDA . INC . D/B/A FLORIDA BLUE
and
INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS
FINANCIAL ARRANGEMENTS
Banking Arrangement
I . Effective Date .
The effective date of this Exhibit is May 1 , 2013 .
I1 . Bank Account.
The Employer agrees to establish a bank account prior to the effective date
of this Agreement, in its own name , at the bank designated by Florida Blue ,
The Employer authorizes Florida Blue to write checks on the bank account
in order to pay claims pursuant to this Agreement. The Employer agrees to
maintain the bank account and the reserve amount as set forth below. The
Employer shall be responsible for the reconciliation of its bank account,
based on information and reports provided by Florida Blue and the bank .
III . Special Banking Information ,
A. Name of Employer (as it is to appear on the checks) - no more than
25 characters :
INDIAN RIVER COUNTY
Be Employer Bank Account Reference Number - 5 characters :
10047
C . Reserve Requirement: $ 108 , 000
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STATE OF FLORIDA
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�`((�� ORIGINAL ON FILE IN THIS
D . Funding Frequency : Dai** S ICE.
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E . Method of Funding : ACH,i ; ; 3
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IV, Administrative Fees : aaaasu as a
A. Administrative fees during the term of the Agreement :
$49 . 95 per enrolled employee per month from May 1 , 2013 through
September 30 , 2015 .
B . Administrative fees after the termination of the Agreement: 15 % of
claims paid .
C . If the Agreement is terminated before September 30 , 2015 , the
Employer .will pay Florida Blue a termination fee of $ 125 , 000 paid
sixty days of termination . If the Agreement is terminated after
September 30 , 2015 , no termination fee will be paid to Florida Blue .
V. Late Payment Penalty
A. A daily charge of . 00038 times the amount of overdue administrative
fees .
VI . Expected Enrollment
A. The administrative fees and reserve requirement referenced above
are based on an expected enrollment of: 1 , 570 .
B . If the " actual enrollment is materially different from this expected
enrollment, Florida Blue reserves the right to adjust the
administrative fees and the reserve requirement as set forth in the
Agreement. Actual administrative fees will be charged based on
actual enrollment.
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