HomeMy WebLinkAbout2009-021 Sic r �
AMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT 1 ° ` " 11 �
THIS AMENDMENT , entered into on atober I , o2CLO;l , 2008 is by and between
Blue Cross and Blue Shield of Florida , Inc. (hereinafter called the "Administrator") and the
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 the Administrator and the Employer ( hereinafter
"Agreement") effective October 1 , 2004 is amended as follows :
1 . Section I , subsection A, is hereby amended to extend the term of the Group Health
Plan until September 30 , 2011 unless the Agreement is terminated earlier in
accordance with the terms of the Agreement .
2 , Section 3 . 5 has been amended to add the following paragraph :
Additionally, the Employer delegates to BCBSF the discretion and
authority to pursue recoveries for claims paid as a result of fraud , abuse
or other inappropriate action by a third party, including the right to opt-out
or opt- in the Employer from any class action . These claims include , but
are not limited to , all legal claims the Employer can assert whether
based on common law or statute such as RICO , antitrust , deceptive
trade practices , consumer fraud , insurance fraud , unjust enrichment ,
breach of fiduciary duty, breach of contract , breach of covenant of good
faith and fair dealing , torts ( including fraud , negligence , and product
liability) , breach of warranty, medical monitoring , false claims and
kickbacks . If BCBSF obtains . .a recovery from any of these efforts ,
BCBSF will reimburse the Employer 's pro rata share of the recovery.
This share is calculated from the Employer 's claims history or covered
members at the time of such recovery, less the Employer 's pro rata �..
share of costs , if any, fees paid to outside counsel and any other costs IR ,.
incurred in obtaining that recovery. BCBSF will not charge the EmployerLU
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for any costs if BCBSF does not obtain a recovery that exceeds those O U °
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3 . Exhibit B to the Agreement is hereby amended , effective October 1 , 2008 . The < o
revised Exhibit B is attached to this Amendment and replaces the Exhibit B w u
previously attached to the Agreement . p "' 3 5
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4 . Except as otherwise specifically noted in this Amendment , all other terms and Q Q m °
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 County
OF FLORID , INC . Commissioners
By : By : (r) n a &J
Title : r/ 4� u ,01 60/ t* f /�7 �7 5 Title : Lown , Admi nN, S m4r
Date : Z 24= 5F Date : lI a (oI 01
EXHIBIT " B "
to the
ADMINISTRATIVE SERVICES AGREEMENT
between
BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC .
and
Indian River County Board of County Commissioners
FINANCIAL ARRANGEMENTS
I . Effective Date
The effective date of this Exhibit is October 1 , 2008
II . Monthly Payments .
A . Each month , BCBSF will notify the Employer of the amount due to satisfy
the previous month ' s paid claims liability . BCBSF also will provide the
Employer with a detailed printout of the previous month ' s claims payments .
The 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 BCBSF by the
payment due date , the payment will be considered past due and subject to
a late payment charge , as set forth below . Additionally , BCBSF will
immediately suspend claims until payment is received by BCBSF .
B . The Employer agrees to pay to BCBSF , each month during and after the
term of this Agreement , an administrative fee , as set forth below . The
Employer agrees to pay to BCBSF , each month , the administrative fee
within ten ( 10 ) days of the written notification of the amount due . If
payment is not received by BCBSF by the due date , the payment will be
considered past due and subject to a late payment charge , as set forth
below . Additionally , BCBSF will immediately suspend claims until payment
is received by BCBSF .
III . Funding Information
A . Method of Funding Transfer : ACH
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IV . Administrative Fees :
A . Administrative fees during the term of the Agreement :
$ 60 . 50 per employee per month from October 1 , 2008 through September
30 , 2009
$60 . 50 per employee per month from October 1 , 2009 through September
30 , 2010 ,
$62 . 31 per employee per month from October 1 , 2010 through September
30 , 2011 ,
B . Administrative fees after the termination of the Agreement: 15 . 0 % of
claims paid .
V . Late Payment Penalty
A . A daily charge of . 00038 times the amount of overdue payment .
VI . Expected Enrollment
A . The administrative fees referenced above are based on an expected
enrollment of: 1 , 737 .
B . If the actual enrollment is materially different from this expected enrollment ,
BCBSF reserves the right to adjust the administrative fees as set forth in
the Agreement . Actual administrative fees will be charged based on actual
enrollment.
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