HomeMy WebLinkAbout2003-314A AMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT 3i �
THIS AMENDMENT , entered into on November 18 , 2003 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
11 1996 is amended as follows :
1 . Section I , subsection 1 . 1 , is hereby amended to extend the term of the Group
Health Plan until October 1 , 2004 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 , 2003 . 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
OF FLORIDA , INC .
By : By .
t � nneth R . Macht ,
Title : P - V v�� ��^ ��4 Title : Chairman` Board of Countymmissioners
Date : �O \ Z�\T 2 Date : November 1 8 , 20
0��3
At �B . K . Bart n , lerlc
By < j \
Deputy Clerk
�► ' P UVED :
CD Q � , , A -�L
,r'
.#c' `rNt; Coun Admini rator
A PPRO ` • D 4S TO FORM
AND UFFICIENCY
BY
T COUNTY ATTO N@Y `
200306304
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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 , 2003 .
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 Bank Account Reference Number - 5 characters :
10047
C . Reserve Requirement : $ 108 , 000
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D . Funding Frequency : Daily
E . Method of Funding : ACH
IV. Administrative Fees :
A. Administrative fees during the term of the Agreement :
$64 . 00 per enrolled employee per month
B . Administrative fees after the termination of the Agreement 15 % of
claims paid .
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: Single - 501 ; Family -
1004 .
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 .
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