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Home My WebLink About2000-270Ai 40 L I r®v �of Flo races iihie5lrteld of Florida Ileallh Options. r JL., 6-0 // F �yy0-�)y C.0 AIVIENIIMEN'I' TO ADMINISTRATIVE SERVICES AGREEMENT effective THIS AMENDMENT, -rata on October 1, 1997 is by and between Blue Cross and Blue Shield of Florida, Inc. (hereinafter called the "Administrator") and Indian Diver County (hereinafter called the "Employer"). In consideration of the mutual and reciprocal promises herein contained, the Administrative Services Agreement between the Administrator and the Employer (hereinafter "Agreement") is amended as follows; 40075.10OR Ps I. The following provision is hereby amended to read as follows: Providers Outside the State of Florida When amounts are paid or payable by the Administrator to Providers of service outside the State of Florida under this Agreement and the Group Health Plan, reimbursement to the out-of-state Provider may be determined based on the Provider arrangements, if any, the Blue Cross and/or Blue Shield Plan in the area where services are provided has with its Provider. Also, the member's financial responsibilities (e.g. coinsurance requirement limits) may be determined using the same Provider arrangements. in those instances the Blue Cross and/or Blue Shield Plan in that area is called a "Host Plan". The Administrator will coordinate with the appropriate Host Plan when reimbursement and financial responsibilities are to be so handled. This is done by use of a special national program called the B1ueCard Program. Participation in this program allows the Administrator to make available out -of --area services at rates that would generally not be available had the Administrator paid the Provider directly. Under the BlueCard Program, Hast Plans may charge the Administrator a fee (called an access fee) for making their negotiated payment rates available on claims incurred. The access fee may be up to 10 percent (but not to exceed $2,000 for any claim) of the discount the Host Plan has obtained from its Providers. The total amount paid by the Administrator to such other plans shall be considered the amount of the claim under this Agreement and shall be the financial responsibility of the Employer. The access fee may be charged only if the Host Plan's arrangement with the Provider prohibits billing Members for amounts in excess of the negotiated payment rate. However, Providers may bill for Deductibles, Coinsurance and/or Copayments. E 40 171 When the Administrator is charged apt access fee, the Administrator will pass the charge along to the Employer as a claims expense. If the Administrator receives an access fee credit, the Administrator will give the Employer a claims expense credit. Access fees are considered a claims expense because they represent claim dollars the Administrator was unable to, or in the case of a credit was able to, avoid, Instances may occur in which the Administrator sloes not pay a claim (or pays only a small amount) because the amounts eligible for payment were applied to the Deductible, Coinsurance or Copayment. In such instances the Host Plan's arrangement with its Provider may allow the negotiated payment rate to apply when the anio unt is fully or mostly a patient obligation. If so, the Administrator will pay the Host Plan's access fee and pass it along to the Employer as a claims expense even though the Administrator paid little or none of the claim. 'Hie negotiated rate paid by the Administrator to the Host Plan under the B1ueCard Program for health care services will be arrived at using one of the following three options. The first option rases the actual price paid on the claim. In limited circumstances this price may be greater than charges (e.g. sometimes payment under a DRG payment system will be treater than charges). The second option uses an estimated price. This price reflects an adjusted aggregate payment expected to result from past or future settlements or other non -claims transactions with all of the Host Plan's Health Care Providers or one or more particular Providers. The third option uses a discount from billed charges. This price is obtained by applying an average savings factor representing the Host Plan's expected savings for all of its Providers or for a specific group of Providers. Estimated and average pricing used under options two and three may be prospectively adjusted. This helps correct for either over or under estimation of past prices. Additionally, the following charges will be paid for each claim processed under the B1ucCard Program as an administrative fee under this Agreement, inpatient Claims - $11; outpatient claims - $11; and professional claims - $5, these charges being subject to change without further notification to the Employer. The calculation of Coinsurance and other member liability for Covered Services will be at the lower of the Provider's billed charges or the negotiated rate the Administrator pays the Host Plan under the BlueCard Program. Also note that statutes in a small number of states require local Blue Cross and/or Blue Shield Plans to use a basis for calculating member liability for Covered Services that does not reflect the entire savings realized or expected to be realized on a V particular claim. When a member receives Covered Services in these states, liability for these services will be calculated using these states' statutory methods. 2. To the extent of any inconsistency between the above provision titled "Providers Outside the State of Florida" and other terms or conditons of the Agreement, the above provision controls. All other terms and condi(ons of the Agreement shall remain unchanged and in full force and effect. IN WITNESS WHEREOF, this Agreement has been executed by the duly authorized representatives of the parties BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. By: 3, A "'D 7&Zjr A. L)6 4,-k4 Title. ✓P ,j 8 t_% Date: ,� �.- a , a-0&2) _ III+]►:1�1t7►'1 �1;ZttiLiili�Illi�1 By:C�� •7r� �� Fran B. Adams Title: Chairman Date: September 12, 2000 particular claim. When a member receives Covered Services in these states, liability for these services will be calculated using these states' statutory methods. 2. To the extent of any inconsistency between the above provision titled "Providers Outside the State of Florida" and other terms or conditons of the Agreement, the above provision controls. All other terms and condi(ons of the Agreement shall remain unchanged and in full force and effect. IN WITNESS WHEREOF, this Agreement has been executed by the duly authorized representatives of the parties BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. By: 3, A "'D 7&Zjr A. L)6 4,-k4 Title. ✓P ,j 8 t_% Date: ,� �.- a , a-0&2) _ III+]►:1�1t7►'1 �1;ZttiLiili�Illi�1 By:C�� •7r� �� Fran B. Adams Title: Chairman Date: September 12, 2000 AMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT THIS AMENDMENT, entered into on 5e , 2000 is by and between Blue Crass and Blue Shield of Florida, Inc. (hereinafter called the "Administrator") and Indian River County (hereinafter called the "Employer'),. in consideration of the mutual and reciprocal promises herein contained, the Administrative Services Agreement between the Administrator and the Employer (hereinafter "Agreement") effective October 1, 1996 is amended as follows: 1. Section I, subsection A, is hereby amended to extend the term of the Group Health Plan until September 30, 2000 unless the Agreement is terminated earlier in accordance with the terms of the Agreement. 2. Exhibit B to the Agreement is hereby amended, effective October 1, 1999. 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 OF FLORIDA, INC. By: ?� Title:' Date: 20001132 INDIAN RIVER COUNTY Fran B. Adams Title; Chairman Date: September i 21 , 2000 BCC Approved V D. EXHIBIT "B" to the ADMINISTRATIVE= SERVICES AGREEMENT between BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC, and INDIAN RIVER COUNTY FINANCIAL ARRANGEMENTS Banking Arrangement I. Effective Date. The effective date of this Exhibit is October 1, 1999. II. 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 the Administrator. The Employer authorizes the Administrator 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 the Administrator 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 B. Employer Sank Account Reference Number - 5 characters: 10047 C. Reserve Requirement: $84,000 200001133 "T" D. Funding Frequency: Daily E. Method of Funding: ACH IV. Administrative Fees: A. Administrative fees during the term of the Agreement: $41,81 per contract per month B. Administrative fees after the termination of the Agreement 12.60% of claims paid. V. Late Pa meat Qenalt A. A daily charge of .00038 times the amount of overdue administrative fees. VI. E=xpected Enrollment A. The administrative fees and reserve requirement referenced above are based on an expected enrollment of: Single - 394; Family - 944. B. If the actual enrollment is materially different from this expected enrollment, the Administrator 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. 200001133 - " 0 4D 40 AMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT THIS AMENDMENT, entered into on September 12 , 2000 is by and between Blue Cross and Blue Shield of Florida, Inc. (hereinafter called the "Administrator") and Indian River County (hereinafter called the "Employer"),. In consideration of the mutual and reciprocal promises herein contained, the Administrative Services Agreement between the Administrator and the Employer (hereinafter "Agreement") effective October 1, 1996 is amended as follows: 1. Section 1, subsection A, is hereby amended to extend the term of the Group Health Plan until September 30, 2001 unless the Agreement is terminated earlier in accordance with the terms of the Agreement. 2. Exhibit B to the Agreement is hereby amended, effective October 1, 2000. The revised Exhibit B is attached to this Amendment and replaces the Exhibit B previously attached to the Agreement. 3. Except as otherwise specifically rioted 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 OF FLORIDA, INC. i By: Title: x A Date: L12 r 200004211 INDIAN RIVER COUNTY By:S- l Fran B. Adams Title: Chairman Date: September, 12. 2000 BCC Approved CI • 0 EXHIBIT "B" to the ADMINISTRATIVE SERVICES AGREEMENT between BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. and INDIAN RIVER COUNTY FINANCIAL ARRANGEMENTS Banking Arrangement I. Effective Date. The effective date of this Exhibit is October 1, 2000. II. 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 the Administrator. The Employer authorizes the Administrator 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 the Administrator and the bank. 111. Special Bankin Information. A. Name of Employer (as it is to appear on the checks) - no more than 25 characters: 2vvvo92V INDIAN RIVER COUNTY B. Employer Bank Account Reference Number - 5 characters: 10047 C. Reserve Requirement: $89,000 -1- D. Funding Frequency: wily E. Method of f=unding: ACH IV. Administrative Fees: A. Administrative fees during the term of the Agreement: $49.49 per contract per month B. Administrative fees after the termination of the Agreement 12.60% of claims paid. V. Late Payment Penalty A. A daily charge of .00038 times the amount of overdue administrative fees. VI. Expected Enrollment 200008212 A. The administrative fees and reserve requirement referenced above are based on an expected enrollment of: Single - 424; Family - 986. B. If the actual enrollment is materially different from this expected enrollment, the Administrator 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. -2-