Common use of Negotiated Arrangements Clause in Contracts

Negotiated Arrangements. Instead of using the BlueCard Program, BCBSRI may process your Enrolled Member claims for covered healthcare services through Negotiated Arrangements. If BCBSRI and GROUP have agreed that Host Blues shall make available custom healthcare provider networks in connection with this Agreement, then the terms and conditions set forth in BCBSRI Negotiated Arrangements for National Accounts with such Host Blues shall apply. Enrolled Member liability calculation will be based on the negotiated price (refer to the description of negotiated price under Section 7.4.1, BlueCard Program) that the Host Blue makes available to BCBSRI that allows GROUP Enrolled Members access to negotiated participation agreement networks of specified participating healthcare providers outside of BCBSRI service area. Where GROUP agrees to use reference-based benefits, which are service-specific benefit dollar limits for specific procedures, based on a Host Blue’s local market rates, Enrolled Members will be responsible for the amount that the healthcare provider bills above the specific reference benefit limit for a given procedure. For a participating provider, that amount will be the difference between the negotiated price and the reference benefit limit. For a nonparticipating provider, that amount will be the difference between the provider’s billed charge and the reference benefit limit. Where a reference benefit limit exceeds either a negotiated price or a provider’s billed charge, the Enrolled Member will incur no additional liability, other than any applicable Enrolled Member cost sharing.

Negotiated Arrangements. Instead of using the BlueCard Program, BCBSRI may process your Enrolled Member claims for covered healthcare services through Negotiated Arrangements. If BCBSRI and GROUP have agreed that Host Blues shall make available custom healthcare provider networks in connection with this Agreement, then the terms and conditions set forth in BCBSRI Negotiated Arrangements for National Accounts with such Host Blues shall apply. Enrolled Member liability calculation will be based on the negotiated price (refer to the description of negotiated price under Section 7.4.18.4.1, BlueCard Program) that the Host Blue makes available to BCBSRI that allows GROUP Enrolled Members access to negotiated participation agreement networks of specified participating healthcare providers outside of BCBSRI service area. Where GROUP agrees to use reference-based benefits, which are service-specific benefit dollar limits for specific procedures, based on a Host Blue’s local market rates, Enrolled Members will be responsible for the amount that the healthcare provider bills above the specific reference benefit limit for a given procedure. For a participating provider, that amount will be the difference between the negotiated price and the reference benefit limit. For a nonparticipating provider, that amount will be the difference between the provider’s billed charge and the reference benefit limit. Where a reference benefit limit exceeds either a negotiated price or a provider’s billed charge, the Enrolled Member will incur no additional liability, other than any applicable Enrolled Member cost sharing.