1st Amendment 10/21/2015AMY REAVILIN, CPA
CLERK OF CIRCUIT COURT &COMPTROLLER
Mom COUNTY, FLORIDA
DATE: October 27, 2015
TO: Teresa Aguiar
Division Director of Employee Services
ATTN.• Maria Fernandez - Gonzalez
FROM: Cheryl Robertson Executive Aide to the Clerk of Court & Comptroller UA4U0L-e dSM
At the October 21, 2015, Board of County Commissioner's meeting the Board granted approval
and execution of Item D6 Amendment to Administrative Services Agreement with Blue Cross and Blue
Shield of Florida (BCBSF) effective November 1, 2015.
Attached is a duplicate original of the above - mentioned for your handling. Should you have any
questions please do not hesitate to contact this office.
CC. County Attorney
Finance
File J
500 Whitehead Street Suite 101, PO Box 1980, Key West, FL 33040 Phone: 305 - 295 -3130 Fax: 305- 295 -3663
3117 Overseas Highway, Marathon, FL 33050 Phone: 305 -289 -6027 Fax: 305 - 289 -6025
88820 Overseas Highway, Plantation Key, FL 33070 Phone: 852 -7145 Fax: 305- 852 -7146
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AMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT
THIS AMENDMENT, entered into on October 21, 2015 is by and between Blue
Cross and Blue Shield of Florida, Inc. d /b /a Florida Blue (hereinafter called "Florida Blue ")
and Monroe 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 November 1, 2011 is amended as follows:
Section I, subsection 1. 1, is hereby amended to extend the term of the Agreement
until December 31, 2020 unless the Agreement is terminated earlier in accordance
with the terms of the Agreement.
2. Section IV, subsection 4.2., is hereby amended deleting the second and third
sentence and replacing it as follows:
Either party may terminate this Agreement with or without cause upon one
hundred and eighty (180) days written notice to the other party.
3. Exhibit B, Financial Arrangements, to the Agreement is hereby amended, effective
October 21, 2015. The revised Exhibit B is attached to this Amendment and
replaces the Exhibit B previously attached to the Agreement.
4. Exhibit E, Performance Guarantees, to the Agreement is hereby amended, effective
October 21, 2015. The revised Exhibit E is attached to this Amendment and
replaces the Exhibit E previously attached to the Agreement.
5. Exhibit F, Discount Guarantees, is hereby attached and made part of the
Agreement, effective October 21, 2015.
6. 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
By:
Title:
Date: 17 L ' l
MONROE COUNTY BOARD OF
COUNTY COMMISSIONERS
By: T
Title: M D
Date:
MqPROE COUNTY ATTORNEY
PPR VED A TO ORM:
CYNTHIA L. HALL
ASSISTANT COUNTY ATTORNEY
Date to 1 3 - " is
EXHIBIT "B"
to the
ADMINISTRATIVE SERVICES AGREEMENT
between
BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. D /B /A FLORIDA BLUE
and
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
FINANCIAL ARRANGEMENTS
Effective Date
The effective date of this Exhibit is October 21, 2015.
II. Weekly Payments
A. Each week, Florida Blue will notify the Employer of the amount due to
satisfy the previous week's paid claims liability. The Employer agrees to
pay the full amount of the bill within thirty (30) business days of the written
notification consisting of a proper invoice and supporting documentation.
If the payment is not received by Florida Blue by the payment due date,
the payment will be considered past due. Florida Blue will immediately
suspend claims until payment is received by Florida Blue.
B. The Employer agrees to pay to Florida Blue, each month during and after
the term of this Agreement, an administrative fee, as set forth below. The
Employer agrees to pay to Florida Blue, each month, the administrative
fee within thirty (30) business days of the written notification consisting of
a proper invoice and supporting documentation of the amount due. If
payment is not received by Florida Blue by the due date, the payment will
be considered past due. Florida Blue will immediately suspend claims until
payment is received by Florida Blue.
III. Fundinq Information
A. Method of Funding Transfer: CHECK
IV. Administrative Fees
A. Administrative fees during the term of the Agreement:
$48.27 per employee per month from November 1, 2014 through
December 31, 2015
$45.75 per employee per month from January 1, 2016 through December
31, 2017.
$47.25 per employee per month from January 1, 2018 through December
31, 2019.
$48.50 per employee per month from January 1, 2020 through December
31, 2020.
B. Florida Blue will pay the Employer a
2015, upon Board approval and
wellness contribution on January
$50,000 wellness contribution on
provided the Agreement remains
payment is due. These funds m
discretion for any wellness relate
execu
1,2
Janu
$100,000 wellness contribution in
tion of this Amendment; a $75,000
016 and January 1, 2017, and a
ary 1, 2018 and January 1, 2019,
in force and effect on the date on which
ay be utilized by Employer at its sole
J initiatives or activities. If the Employer
terminates the Agreement without cause on or before January 1, 2020,
Employer will pay Florida Blue a $150,000 early termination fee.
V
C. Administrative fees after the termination of the Agreement: 15% of claims
paid.
Expected Enrollment
A. The administrative fees referenced above are based on an expected
enrollment of: 1,600.
B. If the actual enrollment is materially different from this expected
enrollment, Florida Blue reserves the right to adjust the administrative fees
as set forth in the Agreement. Administrative fees will be charged based
on actual enrollment. For purposes of this paragraph, the term "materially"
means an increase or decrease of greater than ten percent (10 %).
EXHIBIT "E"
to the
ADMINISTRATIVE SERVICES AGREEMENT
between
BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. D /B /A FLORIDA BLUE
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
PERFORMANCE GUARANTEES
Number of calls that reach the call center and are placed in
queue but do not reach the final destination because the caller :55% 2%
h u before a re b ecomes available.
Average ACD Phone Queue Time
Actual length of time a member waits to speak with a customer 2 %
530 seconds
service as after all ACD options have been chosen.
Blockage Rate
Percentage of calls blocked during business hours. ! <_8% 2%
Enrollment Timeliness
Percentage of ID cards mailed by effective date provided that
the enrollment data is received from the employer 30 days prior ?99%
to the effective date of coverage.
Claims Processing Timeliness
Percentage of provider and subscriber claims processed within
30 calendar days from receipt to the date that a claim has
passed all edits and is pending the issuance of a check,
voucher or denial.
Claims Processing Accuracy
Percentage of clai processed a
Claims Dollar Accuracy
Percentage of claim dollars paid accurately. -
Inquiry Timeliness -- - --
Per centa ge o inquiri fin alize within 7 days
Maximum at Risk is 10 %.
2%
I
2% "
>_97%
I
?97% 2% "
>_98% 2 %`
>_90% 2%
Guarantees are based on National Strategic /Public Sector book of business results.
Performance Guarantees are from January 1, 2016 through December 31, 2016
EXHIBIT "F"
to the
ADMINISTRATIVE SERVICES AGREEMENT
between
BLUE CROSS AND BLUE SHIELD OF FLORIDA. INC. D /B /A FLORIDA BLUE
and
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
DISCOUNT GUARANTEES
Assumptions:
• Applies to In- network provider claims only.
• BCBSF Network and Program Savings Report will be used for validation of results.
• No significant benefit or contribution changes or membership changes by geographic regions.
• Based on enrollment provided in the RFP.
• Blue products only, excluding RX.
• Inpatient hospital claims in excess of $100,000 will be removed in their entirety from the discount
guarantee calculation.
• Does not include COB.
• Does not include ACO /PCMH surcharge.
• Does not include any ancillary products or AOR fees.
• Does not include nationwide BlueCard claims.
• Discount ranges are account specific and apply to total discounts only.
• Results will be provided on a quarterly basis with a final settlement no earlier than the second quarter
of the following year.
• One year offer.
Subject to the foregoing assumptions, the "Network Discount Achieved" will be calculated by dividing the
savings in claim dollars by the Network Provider's Billed Charges, using the following formulas:
Provider Billed Charges — Network Allowed Charges = Savings
Savings / Provider Billed Charges = Network Discount Achieved.
Discount Guarantees are from January 1, 2016 through December 31, 2016