1154* BC/BS Addendum AgrmtTo: City Clerk
RE: Request for Services
The item(s) noted below is/are attached and forwarded to your office for the following action(s):
Development Order
Final Plat (original mylars)
Letter of Credit
Maintenance Bond
Ordinance
Performance Bond
Resolution
Once completed, please:
❑ Return original
❑ Return copy
❑
Special Instructions:
❑
Mayor's signature
❑
Recording
❑
Rendering
®
Safe keeping (Vault)
❑
Record Custodian
Please maintain this original copy of Blue Cross Blue Shield Addendum Agreement this is
effective January 1, 2016.
Please advise if you have any questions regarding the above.
Thaq you!
rom
T:\Dept_forms\City Clerk Transmittal Memo - 2009.doc
Date
AMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT
THIS AMENDMENT, entered into on—tZ;, 17 , 2015 is by and
between Blue Cross and Blue Shield of Florida, Inc. d/b/a Florida Blue (hereinafter called
"Florida Blue") and City of Sanford (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, 2004 is amended as follows:
Section I, subsection 1.1, is hereby amended to extend the term of the Group Health
Plan until December 31, 2018 unless the Agreement is terminated earlier in
accordance with the terms of the Agreement.
2. Exhibit B to the Agreement is hereby amended, effective January 1, 2016. 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.
ATTEST.-
ATTEST.-
Orwk
City ClerkCfet-
BLUE CROSS AND BLUE SHIELD
OF FLORIDA, INC. DIB/A FLORIDA
BLUE
Y'
Title:
Date: a % 11
CITY OFFSANFOR
4
By: Jeff-r-imp{ett Ve Ir ra w' � i i►c �+ns
Vice- Mayor
Date:
For the use and reliance of City of Sanford
only. Approved as to form and legal
sufficiency.
William L. Colbert, City Attorney
EXHIBIT "B"
to the
ADMINISTRATIVE SERVICES AGREEMENT
between
BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. D/B/A FLORIDA BLUE
and
CITY OF SANFORD
FINANCIAL ARRANGEMENTS
I. Effective Date
The effective date of this Exhibit is January 1, 2016.
II. Monthly Payments.
A. Each month, Florida Blue will notify the Employer of the amount due to
satisfy the previous month's paid claims liability. Florida Blue 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 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. 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 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:
$49.95 per enrolled employee per month from January 1, 2016 through
December 31, 2017.
$51.50 per enrolled employee per month from January 1, 2018 through
December 31, 2018.
B. Administrative fees after the termination of the Agreement: 15% of claims
paid. This should not exceed seven months of the current administration
fee, times the current enrollment, at time of cancellation.
C. Florida Blue will pay Employer a $75,000 wellness contribution in 2015,
upon Employer execution of the Amendment. This is to be utilized by the
Employer for any wellness related initiatives or activities.
D. If the Employer terminates the Agreement prior to December 31, 2018,
Employer will pay Florida Blue a termination fee of $75,000.
V. Late Payment Penalty
A. A daily charge of .00038 times the amount of overdue payment.
The provisions of the Prompt Payment Act shall apply to this Agreement.
VI. Expected Enrollment
A. The administrative fees referenced above are based on an expected
enrollment of: 400.
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.