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HomeMy WebLinkAbout2022-117AAMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT THIS AMENDMENT, entered into on jjkA G 7 , 2022 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, 2026 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, 2022. 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 FLORIDA, INC. D/B/A FLORIDA COUNTY COMMISSIONERS BLUE r f•c° By: Y o�.i B . Title: _yp,, Sales Title: Date: Au ust 1 2022 Date: August 1, 2022 APPROVEDO F� `r'"'1 AND LKI BY WILLIAM K. DEBRAAL DEPUTY COUNTY ATTORNEY Attest Jeffrey It Smith, Clerk of Circuit Cowt and ConVWlet Dgx*Clo* 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, 2022 II. 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: $49.55 per enrolled employee per month from October 1, 2022 through September 30, 2023. -1- $49.55 per enrolled employee per month from October 1, 2023 through September 30, 2024. $51.04 per enrolled employee per month from October 1, 2024 through September 30, 2026. B. Florida Blue will pay Employer a $75,000 wellness contribution upon the Board's approval of renewing this Agreement, and $50,000 per year, each year for four 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 2.11% (2022) of Network Savings for PPO provider claims and 3.79% 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 the Section InterPlan Arrangements. 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 which is the geographic area 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 of 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 -2- utilizing that provider's charges. The Allowed Amount for Emergency Services provided by Non -Participating or Non -Contracting Providers will pay in accordance with the definition of Maximum Payment in the Plan of Benefits. 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: 1,650. 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. -3-