HomeMy WebLinkAbout2018-105BAMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT
THIS AMENDMENT, entered into on ,J,,.,PST_ , 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, is hereby amended to extend the term of the Agreement
until September 30, 2023 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, 2018. 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` . ••
,.�c,S10NER "
By: By: �Pv
Peter D. O'Brycfh
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Title: Vice President, Sales Operations Title: rh;,;rmgn ,: t :ol
Date: December 7, 2018 Date: June 5 20
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APPMOVF-D AS TO FORM
AND LEGAL SUFFICIENCY
BY
DYLAN REINGOLD
COUNTY ATTORNEY
ATTEST: Jeffrey R. Snitl+Y Clerk
of troller
BY:
e
EXHIBIT "13"
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, 2018
Monthly Payments.
A. Each month, Florida Blue will notify Employer of the amount due to satisfy
the previous month's paid claims liability. Florida Blue also will provide
Employer with a detailed printout of the previous month's claims payments.
Employer agrees to pay the full amount of the bill within ten (10) days of the
written notification. If the payment is not received by Florida Blue by the
payment due date, the payment will be considered past due and subject to a
late payment charge, as set forth below. Additionally, Florida Blue will
immediately suspend claims until payment is received by Florida Blue.
B. Employer agrees to pay to Florida Blue, each month during and after the term
of this Agreement, an administrative fee, as set forth below. Employer agrees
to pay to Florida Blue, each month, the administrative fee within ten (10) days
of the written notification of the amount due. If payment is not received by
Florida Blue by the due date, the payment will be considered past due and
subject to a late payment charge, as set forth below. Additionally, Florida
Blue will immediately suspend claims until payment is received by Florida
Blue.
III. Funding Information
A. Method of Funding Transfer: ACH
IV. Administrative Fees:
A. Administrative fees during the term of the Agreement:
$50.00 per enrolled employee per month from October 1, 2018
through September 30, 2019.
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$51.50 per enrolled employee per month from October 1, 2019
through September 30, 2021.
$53.05 per enrolled employee per month from October 1, 2021
through September 30, 2023.
B. Florida Blue will pay Employer a $50,000 wellness contribution, on October
1, 2018 upon the Board's approval of renewing this Agreement, and $50,000
per year, each year for five years upon renewing this Agreement for any
wellness related initiatives or activities.
C. Administrative fees after the termination of the Agreement: 15% of claims
paid.
D. Access fees of up to 2.40% of Network Savings for PPO provider claims and
4.51 % of Network savings for Traditional provider claims may be assessed
for claims incurred in states under the BlueCard program as explained in
more detail under Section III, subsection 3.9 below. This access fee will not
exceed two thousand dollars ($2,000) for any one claim and will not apply in
Florida, South Carolina or in Consortium Plan service areas where enrolled
members reside as long as enrollment continues to be equal to or greater
than one thousand (1,000) contracts. On the first anniversary date after
enrollment falls below one thousand (1,000) contracts, access fees will apply
in those Consortium Plan service areas where enrolled members reside and
Consortium fees were not previously established. Access fees will also apply
in Consortium Plan service areas where no enrolled members reside. A
determination of the Consortium Plan service areas that will not apply access
fees for services rendered to members will be made on the basis on
enrollment on each subsequent anniversary of this Agreement's effective
date. Access fees will be applied on the basis of where the service was
incurred, and not where the member resides.
Network Savings is defined as the total of the amounts computed by
subtracting each "allowed amount" for a particular service under the terms
of a participating provider's written agreement from each "billed amount" for
such service. In no event shall the term "Network Savings" include
duplicate charges or billed amounts for services or supplies not covered
under the Employer's Plan. The term "allowed amount" means the amount
received as payment in full by a participating provider, under that provider's
written agreement, from both Florida Blue and covered individuals under
Employer's Plan for claims submitted to, and paid by Florida Blue for a
particular covered service, and the term "billed amount" means the amount
which would be received by such provider for the same covered service
utilizing that provider's charges.
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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.
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