Legal Entity Agency Agreement - Florida Blue - BCBSF

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BlueScript A Ded Copay Plan 1BlueScript C Copay Plan 1BlueScript C Copay Plan 2BlueScript C Copay Plan 3BlueScript C Copay Plan 4BlueScript C Copay Plan 5BlueScript C Ded Coin Plan 1BlueScript C Ded Copay Plan 3BlueScript C Ded Copay Plan 4BlueScript E Generic Cpy Pl 2BlueScript Ii Drug Plan 01BlueScript Ii Drug Plan 02BlueScript Ii Drug Plan 03BlueScript Ii Drug Plan 04BlueScript Ii Drug Plan 05BlueScript Ii Drug Plan 06BlueScript Ii Drug Plan 09BlueScript Ii Drug Plan 10BlueScript Ii Drug Plan 12BlueScript Ii Drug Plan 13BlueScript Ii Drug Plan 14BlueScript Iii Drug Plan 01BlueScript Iii Drug Plan 02BlueScript Iii Drug Plan 04BlueScript Iii Drug Plan 06BlueScript Iii Drug Plan 07BlueScript Iii Drug Plan 08BlueScript Nasco Drug PlanBlueScript V Drug Plan 1BlueScript V Drug Plan 2BlueScript V Drug Plan 3BlueScript V Drug Plan 6BlueScript V Drug Plan 7Dap High With OrthoDap High With Ortho-R1Dap High Without OrthoDap Low With OrthoDap Low With Ortho-R1Dap Med With OrthoDap Med With Ortho-R1Dap Med With Ortho-R2Dap Med Without OrthoDap UCR With OrthoDap UCR Without OrthoElect Care Plus Option 100-R2Elect Care Plus Option 105Elect Care Plus Option 109Elect Care Plus Option 200-R2Elect Care Plus Option 206Elect Care Plus Option 300Elect Care Plus Option 300-R2Elect Care Plus Option 300-R3Elect Care Plus Option 500-R2Fl Small Business Option 01-R2Fl Small Business Option 02-R2Fl Small Business Option 03-R2FSA Plan 001FSA Plan 005FSA Plan 006FSA Plan 007FSA Plan 009Group Essential Option 02-R1Group Essential Option 03Group Option 01-R1Group Option 05-R2Group Option 05-R3Group Option 07Group Option 07-R1Group Option 07-R2Group Option 07-R3Group Option 09-R2HMO Drug Option 01HMO Drug Option 01-R1HMO Drug Option 02HMO Drug Option 02-R1HMO Drug Option 03HMO Drug Option 03-R1HMO Drug Option 04HMO Drug Option 04-R1HMO Drug Option 05HMO Drug Option 05-R1HMO Drug Option 06HMO Option 01HMO Option 02HMO Option 02-R1HMO Option 03HMO Option 03-R1HMO Option 04HMO Option 04-R1HMO Option R01HMO Option R01-R1HMO Option R02HMO Option R02-R1HMO Option R03HMO Option R03-R1HMO Option R04HMO Option R04-R1HMO Option/04Hospital Indemnity SubsidyHRA Plan 004HRA Plan 005Major Medical Group Type MMediscript Ii Drug Plan 01Mediscript Ii Drug Plan 1Mediscript Pharmacy ProgramMediscript PharmacyProgram-R1Network Advantage Pl 1750Network Advantage Pl 1751Network Advantage Pl 1752Network Advantage Pl 1753Network Advantage Pl 1754Point Of Service 32-R2Point Of Service NascoPoint Of Service Opt. R20c-R1Point Of Service Opt. R22c-R1Point Of Service Opt. R24c-R1Point Of Service Opt. R26c-R1Point Of Service Opt. R27c-R1Point Of Service Opt. R28c-R1Point Of Service Opt. R30c-R1Point Of Service Opt. R32c-R1Point Of Service Opt. R36c-R1Point Of Service Opt. R37c-R1Point Of Service Opt. R50c-R1Point Of Service Opt. R52c-R1Point Of Service Opt. R56c-R1Point Of Service Opt. R57c-R1Point Of Service Option 10cPoint Of Service Option 10c-R1Point Of Service Option 10-R1Point Of Service Option 10-R2Point Of Service Option 11c-R1Point Of Service Option 12cPoint Of Service Option 12-R1Point Of Service Option 12-R2Point Of Service Option 13-R2Point Of Service Option 14cPoint Of Service Option 14c-R1Point Of Service Option 14-R1Point Of Service Option 20Point Of Service Option 20cPoint Of Service Option 20c-R1Point Of Service Option 20-R1Point Of Service Option 20-R2Point Of Service Option 20-R3Point Of Service Option 21c-R1Point Of Service Option 21-R1Point Of Service Option 21-R2Point Of Service Option 22Point Of Service Option 22cPoint Of Service Option 22c-R1Point Of Service Option 22-R1Point Of Service Option 22-R2Point Of Service Option 22-R3Point Of Service Option 23Point Of Service Option 23cPoint Of Service Option 23c-R1Point Of Service Option 23-R1Point Of Service Option 23-R2Point Of Service Option 23-R3Point Of Service Option 24cPoint Of Service Option 24c-R1Point Of Service Option 24-R1Point Of Service Option 24-R2Point Of Service Option 25cPoint Of Service Option 25-R1Point Of Service Option 25-R2Florida Blue Agency Agreement 17
Page 10 and 11: follow-up documentation pursuant to
Page 12 and 13: the compliance date of such finalre
Page 14 and 15: Addendum A: Company ProductsJANUARY
Page 18 and 19: Point Of Service Option 25-R3Point
Page 20 and 21: Addendum B: Agency “Good Standing
Page 22 and 23: Location-specific rates are based o
Page 24: Addendum D: Operating & Hardware Re

Legal Entity Agency Agreement - Florida Blue - BCBSF

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