HomeMy Public PortalAboutBlue Cross & Blue Shield of FL Accounting & Rentention Agreement1
BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.
HEALTH OPTIONS, INC.
ACCOUNTING AND RETENTION AGREEMENT
(Proshare)
This is an Agreement (hereinafter "Agreement") between Blue Cross Blue Shield of
Florida, Inc. d/b/a Florida Blue and Health Options, Inc., (hereinafter jointly referred to as
"Florida Blue"), located at 4800 Deerwood Campus Parkway, Jacksonville, Florida 32246
and CITY OF CRESTVIEW, (hereinafter "the Group") located at 198 NORTH WILSON
STREET, CRESTVIEW, FL 32536.
WHEREAS, the Group requests Florida Blue to provide a health maintenance
organization (hereinafter "HMO") and a Point -of -Service insurance program, (hereinafter
jointly referred to as GHP "the Group Health Plan") to its employees and their covered
dependents (hereinafter "Group Member(s); and;
WHEREAS, Health Options, Inc., has agreed to provide the HMO part of the GHP, and
Florida Blue has agreed to provide the insurance part of the GHP; and
WHEREAS, each of the parties to this Agreement seeks to set forth in writing the terms
and conditions of their Agreement.
NOW THEREFORE, for good and valuable consideration, the parties agree to these
terms and conditions:
I. TERM
The initial term of this Agreement shall begin on October 1, 2014, (the effective date)
and shall end on September 30, 2017 (the termination date), unless otherwise
terminated or renewed in accordance with the provisions of this Agreement.
During the term of this Agreement, the Group agrees to: a) maintain enrollment that does
not decline to one hundred (100), or fewer contracts for two consecutive months or three
nonconsecutive months during a single contract period, and b) meet or exceed the
minimum participation guidelines set forth in the True Group Application. In the event the
Group is unable to maintain adequate enrollment, this Agreement may be terminated and
no settlement will be prepared and the Group will not be eligible for this funding
arrangement in the future.
11. BENEFIT PLAN
Florida Blue will pay benefits to all eligible Group Members in accordance with the
provisions of this Agreement and the GHP.
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III. PREMIUM PAYMENTS
The Premium Rates, Prepayment Fees, and Supplemental Charges for the GHP are
payable in advance to Florida Blue at the address set forth above. The premiums for the
program are set forth in Exhibit A.
IV. SETTLEMENT ACCOUNTING
Within one hundred twenty (120) days after the end of the initial term of the Agreement
and any renewal term, Florida Blue shall prepare and furnish to the Group a Settlement
Accounting of their operations of that term. This Settlement Accounting shall include
operations under all coverages of the Agreement and shall set forth the following:
(a) Earned Premium
(b) Incurred Claims less claims in excess of the pooling point
(c) Capitation Charges, if applicable
(d) Pooling Charges (not included in administrative charges)
(e) Administrative Charges as set forth on Exhibit A
If Earned Premium is greater than the sum of Incurred Claims less claims in excess of the
pooling point, Capitation Charges, Pooling Charges and Administrative Charges, a
portion of this excess will be retumed to the Group as determined by the following:
(a) After completion of the Oct 1, 2014 - Sept 30, 2015 policy year - 50% of the
excess
(b) After completion of the Oct 1, 2015 - Sept 30, 2016 policy year - 50% of the
excess
(c) After completion of the Oct 1, 2016 - Sept 30, 2017 policy year - 50% of the
excess
If the Group cancels prior to the completion and acceptance of the Settlement
Accounting, no excess premium will be retumed for the prior policy year or the current
policy year. Excess premium for each policy will be determined solely from the results of
that year. Prior gains or deficits will not be carried forward to subsequent years.
If Eamed Premium is less than the sum of Incurred Claims less claims in excess of the
pooling point, Capitation Charges, Pooling Charges and Administrative Charges, the
deficit will be retained by Florida Blue.
V. TERMINATION
This Agreement may be terminated at any anniversary of the effective date by either party
by giving the other party at least 45 days prior written notice of such termination.
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VI. MODIFICATION OF RATES
Rates for the term of this Agreement will remain in effect, as set forth in Exhibit A,
provided there is no material change to the Benefit Contracts, the enrollment, or any other
risk factor, as determined by Florida Blue. Thereafter, all rates set forth in Exhibit A of this
Agreement are subject to change by Florida Blue at any time following at least forty-five
(45) days prior written notice to the Group. The revised rates, administrative charge and
pooling charge will be set forth and presented to the Group on a revised Exhibit A. All
other provisions of this Agreement shall remain in effect without modification.
VII. LATE PAYMENT/CHARGE
In the event the Group fails to make any payment due under this Agreement, in full, prior
to the applicable due date, such payment may be made to Florida Blue up to ten (10)
days after such due date without a late payment charge. Payments received by Florida
Blue eleven (11) to thirty-one (31) days after such due date are subject to a late payment
charge. The Group shall pay any late payment charge to Florida Blue immediately upon
receipt of the notice of such charge.
In the event any charge under this Agreement is not paid, in full, by the Group to Florida
Blue within thirty-one (31) days after the applicable due date, this Agreement will
automatically terminate as of the applicable due date. In the event this Agreement
terminates retrospectively for any reason, the Group shall be liable, in addition to all other
liabilities set forth in this Agreement, for any claim(s) paid by Florida Blue which were
incurred after the termination date.
All payments due for changes during the Agreement period must be received by Florida
Blue in order for the Group to share in any excess.
VIII. RENEWAL
This Agreement shall automatically renew/extend for additional one-year period(s), after
the termination date, at the rates then in effect (the renewal rates), unless either party
notifies the other party of its intent not to extend this Agreement at least forty-five (45)
days prior to the applicable Anniversary Date. The renewal rates will be set forth and
presented to the Group on a revised Exhibit A.
IX. INCONSISTENCIES
If the provisions of this Agreement are, in any way, inconsistent with the provisions of the
Benefit Contract(s), then the provisions of this Agreement shall prevail, and the other
provisions shall be deemed modified but only to the extent necessary to implement the
intent of the parties expressed herein.
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X. SURVIVAL
The rights and obligations of the parties, as set forth herein, shall survive the termination
of this Agreement to the extent necessary to effectuate the intent of the parties as
expressed herein.
XI. WAIVER OF BREACH
The failure by either party, at any time, to enforce or to require the strict adherence to any
provision of this Agreement shall not be deemed to be a waiver of such provision or any
other provision of this Agreement.
XII. GOVERNING LAW
This Agreement and the rights of the parties hereunder, shall be construed according to
the laws of the State of Florida.
XIII. SEVERABILITY
In the event any provision of this Agreement is deemed to be invalid or unenforceable, all
other provisions shall remain in full force and effect.
XIV. AMENDMENT
This Agreement may be amended at any time upon mutual, written agreement of both
parties, except that Florida Blue may make changes necessary to comply with State and
Federal laws upon 60 days notice to the Group.
XV. ENTIRE AGREEMENT
This Agreement, including its Exhibits, the application(s) for coverage, and the Benefit
Contract(s) constitute the entire Agreement between the Group and Florida Blue. Any
prior agreements, promises, or representations, either oral or written, relating to the
subject matter of this Agreement, and not expressly set forth in this Agreement, are of no
force or effect.
XVI. NOTICES
Any notice, required or permitted under this Agreement, shall be deemed given if hand
delivered or if mailed by United States mail, or an overnight mail service (e.g., Federal
Express), postage prepaid, to the applicable address as set forth above or to such other
address as a party may designate, in writing, to the other party. Such notice shall be
deemed effective as of the date so deposited or delivered.
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XVII. SEPARATE CORPORATIONS
Florida Blue and Health Options, Inc., are separate corporations. Nothing in this
Agreement shall be construed, for any purpose whatsoever, to make either liable for the
actions of the other.
XVIII. PROVIDER NETWORKS
Florida Blue Health Care Provider Networks are subject to change and may be modified
at any time during the term of this Agreement without notice to or consent of the Group or
any Group Member.
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BLUE CROSS AND BLUE SHIELD OF
FLORIDA, INC. D/B/A FLORIDA BLUE &
HEALTH OPTIONS, INC.
•
By:
Name: I Jambi J. Condit
By:
Name:
Title: Vice President and Chief Title:
Underwriting Officer
Date: a /7/YDate:
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EXHIBIT A
TO THE
ANNUAL ACCOUNTING AND RETENTION AGREEMENT
WITH
CITY OF CRESTVIEW
GROUP NO. 59530
A. Premium rates effective: October 1, 2014
BOP 03559
$10/$30/$50 Fbc
BOP 05770
$10/$30/$50 Fbc
HMO 059
$10/$30/$50 Fbc
Single
$572.82
$543,24
$543.28
Spouse
$1,271.67
$1,205.99
$1,206.09
Child(ren)
$1,042.53
$988.69
$988,77
Family
$1,758.57
$1,667.74
$1,667.87
B. Administrative charges effective: October 1, 2014
23.15% of earned premium
C. Pooling effective: October 1, 2014
1. Pooling Level: $115,000
2. Pooling Charges: 7.93% of earned premium
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