HomeMy WebLinkAbout2018-050!Hut t;uvy
€RTIFICATIONON LAST PAGI
IRWITH CLERK
AMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT
THIS AMENDMENT, entered into on March 13, 2018 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:
Section I, subsection 1. 1, establishes the term of the Agreement until September 30,
2018 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, 2015. 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. D/B/A FLORIDA
BLUE
M
Title:
Date:
INDIAN RIVER COUNTY BOARD OF
COUNTY COMMISSIONERS
in
Title: Chairman
Date:
�on�M�sS••.
SER COUNT
APPROVED AS TO FORM
AND LEGAL SUF=FIC CY
COY _
DYLAN REINGOLD
COUNTY ATTORNEY
ATTEST: Jeffrey R. Smith, Clerk of Court
and Comptroller
BY:
Deputy Clerk'
, I TIFICATION ON LAST PAGI
I.R. SMITH QERK
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
Effective Date.
The effective date of this Exhibit is October 1, 2015.
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 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
B. Employer Bank Account Reference Number - 5 characters:
10047
C. Reserve Requirement: $108,000
D. Funding Frequency: Daily
E. Method of Funding: ACH
-1-
IV. Administrative Fees:
A. Administrative fees during the term of the Agreement:
$49.95 per enrolled employee per month from October 1, 2015
through September 30, 2017.
$50.00 per enrolled employee per month from October 1, 2017
through September 30, 2018.
B. Administrative fees after the termination of the Agreement: 15% of
claims paid.
C. Florida Blue will pay Employer a $50,000 wellness contribution upon
the Board's approval of renewing this Agreement, for any wellness
related initiatives or activities; Florida Blue will pay an additional
$50,000 wellness contribution on October 1, 2015, for a total of
$100,000.
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: 1,500.
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.
,r FLORIDA
s iNDI:AN RIVER COUNTY
THIS IS TO CERTIFY THAT THIS IS
A TRUE AND CORRECT COPY OF
I THE ORIGINAL ON FILE fN THIS
i OFFICE. I
[j E 'RE SMITH, CLERK 9
I n�,
�rE _
-2-_ ��3
I