Duties and Responsibilities of Florida Blue. Generally: It is understood and agreed that Florida Blue is empowered and required to act with respect to the Group Health Plan only as expressly stated herein. The City and Florida Blue agree that Florida Blue's role is to provide administrative claims payment services, that Florida Blue does not assume any financial risk or obligation with respect to claims, that the services rendered by Florida Blue under this Contract shall not include the power to exercise control over the Group Health Plan's assets, if any, or discretionary authority over the Health Care Plan's operations, and that Florida Blue will not for any purpose, under ERISA or otherwise, be deemed to be the "Plan Administrator" of the Group Health Plan or a "fiduciary" with respect to the Group Health Plan. Florida Blue's services hereunder are intended to and shall consist only of ministerial functions. The Group Health Plan's "Administrator" for purposes of ERISA is the City. Enrollment: Forms and I.D. Cards: Florida Blue shall enroll those individuals who have completed an application and are identified by the City as eligible for benefits under the Group Health Plan on the effective date of this Contract, and subsequently during the continuance of this Contract. Florida Blue shall be entitled to rely on the information furnished to it by the City. Florida Blue shall furnish to the City, for distribution to persons participating in the Group Health Plan, a supply of identification cards, benefit plan descriptions, forms to be used for submission of claims and enrollment, and any other forms necessary for the administration of the Group Health Plan, as determined by Florida Blue. Claims Processing: Florida Blue shall provide claims processing services on behalf of the City for all properly submitted claims, in accordance with the benefits and procedures set forth in Exhibit 4, using funds solely supplied by the City, as set forth in Section XI, Compensation. Florida Blue shall furnish each claimant with an explanation of each claim that is paid, rejected, suspended or denied. For value-based reimbursement programs Florida Blue enters into with participating providers, an applicable per member per month charge may be included in lieu of a claim level surcharge. For purposes of this Contract, the term "claim(s)" shall be defined as the amount paid or payable by Florida Blue to providers of services and/or covered group members under this Contract and the Group Health Plan, and in conformity w...
Duties and Responsibilities of Florida Blue
