Modifications or Changes to Inter-Plan Arrangement Fees or Compensation. Modifications or changes to Inter-Plan Arrangement fees are generally made effective Jan. 1 of the calendar year, but they may occur at any time during the year. In the case of any such modifications or changes, Claim Administrator shall provide Employer with at least thirty (30) days’ advance written notice of any modification or change to such Inter-Plan Arrangement fees or compensation describing the change and the effective date thereof and Employer’s right to terminate this Agreement without penalty by giving written notice of termination before the effective date of the change, which notice will be effective after ninety (90) days in accordance with Section 6.1(a) of the Agreement. If Employer fails to respond to the notice and does not terminate this Agreement during the notice period, Employer will be deemed to have approved the proposed changes, and Claim Administrator will then allow such modifications to become part of this Agreement.
Modifications or Changes to Inter-Plan Arrangement Fees or Compensation. Modifications or changes to Inter-Plan Arrangement fees (Access and AEA) are generally made effective Jan. 1 of the calendar year, but they may occur at any time during the year. In the case of any such modifications or changes, BCBSNE shall provide THE GROUP with at least thirty (30) days’ advance written notice of any modification or change to such Inter-Plan Arrangement fees or compensation describing the change and the effective date thereof and THE GROUP’s right to terminate this Agreement without penalty by giving written notice of termination before the effective date of the change. If THE GROUP fails to respond to the notice and does not terminate this Agreement during the notice period, THE GROUP will be deemed to have approved the proposed changes, and BCBSNE will then allow such modifications to become part of this Agreement.
Modifications or Changes to Inter-Plan Arrangement Fees or Compensation. Modifications or changes to Inter-Plan Arrangement fees (Access and AEA) are generally made effective Jan. 1 of the calendar year, but they may occur at any time during the year. In the case of any such modifications or changes, BCBSNE shall provide THE GROUP with at least thirty (30) days’ advance written notice of any modification or change to such Inter-Plan Arrangement fees or compensation describing the change and the effective date thereof and THE GROUP’s right to terminate this Agreement without penalty by giving written notice of termination before the effective date of the change. If THE GROUP fails to respond to the notice and does not terminate this Agreement during the notice period, THE GROUP will be deemed to have approved the proposed changes, and BCBSNE will then allow such modifications to become part of this Agreement.
C. [Rx Nebraska Program Fees: Prime Therapeutics, LLC, (Prime) is the Pharmacy Benefit Manager which processes pharmacy claims for the Rx Nebraska Program. For pharmacy claims, BCBSNE utilizes Prime to provide network access to network participants and to provide mail service. The Rx Nebraska Program terms and fees are described in Attachment 5.] [Rebates received from manufacturers of drugs and supplies on claims that are processed through THE GROUP’s medical benefits will be retained by BCBSNE.] [Rebates received from manufacturers of drugs and supplies on claims that are processed through THE GROUP’s medical benefits will be passed back to THE GROUP.] [THE GROUP’s Net Paid Claims will not be reduced by the amount of THE GROUP’s rebates (regardless of whether or not THE GROUP has retained the rebates) for purposes of calculating whether THE GROUP has exceeded its Aggregate Stop Loss Amount. Under the Patient Protection and Affordable Care Act (PPACA) all Food and Drug Administration approved contraceptive methods for women with reproductive capacity are required to be provided with no cost sharing. BCBSNE does not provide prescription drug benefits for THE GROUP. Accordingly, because BCBSNE does not provide prescription drug benefits for THE GROUP, BCBSNE will not provide any prescription drug benefits, including benefits for contraceptives typically covered under a prescription drug program (e.g. birth control pills, patches, rings, etc.). BCBSNE will provide benefits under the medical portion of the health benefit plan for medical services when billed with a contraceptive diagnosis. By accepting coverage with BCBSNE, TH...
Modifications or Changes to Inter-Plan Arrangement Fees or Compensation. Modifications or changes to Inter-Plan Arrangement fees are generally made effective Jan. 1 of the calendar year, but they may occur at any time during the year. In the case of any such modifications or changes, BCBSM shall provide Group with at least sixty (60) days’ advance written notice of any modification or change to such Inter-Plan Arrangement fees or compensation describing the change and the effective date thereof and Group right to terminate the ASC without penalty by giving written notice of termination before the effective date of the change. If Group fails to respond to the notice and does not terminate the ASC during the notice period, Group will be deemed to have approved the proposed changes, and BCBSM will then allow such modifications to become part of the ASC. BlueCard Program Access Fees may be charged separately each time a claim is processed through the BlueCard Program. All other BlueCard Program-related fees are included in BCBSM’s administrative fee, unless otherwise agreed to by Group. The BlueCard Access Fee is charged by the Host Blue to BCBSM for making its applicable Provider network available to Group’s Enrollees. The BlueCard Access Fee will not apply to Nonparticipating Provider Claims. The BlueCard Access Fee is charged on a per-Claim basis and is charged as a percentage of the discount / differential BCBSM receives from the applicable Host Blue and is capped at $2,000.00 per Claim. The percentages for 2021 are:
Modifications or Changes to Inter-Plan Arrangement Fees or Compensation. Modifications or changes to Inter-Plan arrangement fees are generally made effective January 1 of the calendar year, but they may occur at any time during the year. In the case of any such modifications or changes, BlueCross shall provide Employer with at least thirty (30) days’ advance written notice of any modification or change to such Inter-Plan arrangement fees or compensation describing the change and the effective date thereof and Employer’s right to terminate this Agreement without penalty by given written notice of termination before the effective date of this change. If Employer fails to respond to the notice and does not terminate this Agreement during the notice period, Employer will be deemed to have approved the proposed changes, and BlueCross will then allow such modifications to become part of this Agreement. DocuSign Envelope ID: CD93B45A-0105-43E7-9602-5AE5EB65AF29 DocuSign Envelope ID: 00C2B362-1FE5-4A7F-86FB-24039505711D In the event that any Member is entitled to continuation of their benefits under the Benefit Documents, BlueCross will continue to perform its duties under this Agreement with regard to that Member as outlined below. That Member shall be charged the amount allowed by law (currently, 102% of the premium equivalent charged to active Subscribers, and 150% if the Member is disabled). BlueCross’s and Employer’s obligations under this Exhibit shall terminate upon termination of this Agreement.
1. When an eligible employee (and/or his or her spouse) first enrolls in Employer’s Plan, and Employer has notified BlueCross of this enrollment, BlueCross shall:
1.1. Issue an initial COBRA notice to the eligible employee at the home address supplied by Employer. We will send a single notice to the eligible employee and spouse if BlueCross’s information is that he or she reside at the same address and enrolled at the same time;
1.2. Send a separate notice to the spouse, if:
1.2.1. The spouse lives at a separate address from the eligible employee (and BlueCross is made aware of this by Employer prior to issuing the notice); or
1.2.2. The spouse becomes enrolled in Employer’s Plan at a different time from the eligible employee;
1.3. Issue these notices within 14 days of the date Employer notifies BlueCross that the eligible employee and/or spouse has enrolled.
