Legal Entity Agency Agreement - Florida Blue - BCBSF

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Location-specific rates are based on county of group headquarters.Commissions paid in error or overpayments must be repaid to Florida Blue/HOI. If a group cancels,commissions will be charged back based on the group cancellation date. For groups that reinstate as a whole,commissions will be paid retroactive to reinstatement date based on the contract count at the time ofreinstatement.No adjustments will be paid for any contracts that are added or terminated retroactively for active groups.This commission schedule applies to group business submitted by Appointed Agents.Classification calculations include only 4+ enrolled groups.New Sales include groups that have not enrolled with Florida Blue/HOI within the 12-month period prior tothe new enrollment effective date.Group Retiree CommissionsGroup Retiree Product* New Sale Rates Renewal RatesMA-PD, PPO, HMO, & PFFSProducts$200 per contract annually $100 per contract annuallyMedicare Part D $50 per contract annually Not ApplicableMedicare Supplement RetireeProduct $150 per contract annually Not Applicable* These products are separate and distinct from Over 65 Medicare Advantage products.Group Retiree Commission AssumptionsGroup Retiree commissions are paid annually at the time of new sale and on a group’s renewal date.No adjustments for contracts added or terminated after the new sale effective month will be paid.No adjustments for contracts added or terminated after the renewal effective month will be paid.Florida Blue Agency Agreement 22
FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (FCL) COMMISSIONSCHEDULEThe ancillary products listed here are offered by Florida Combined Life Insurance Company, Inc. (FCL). FCL is anaffiliate of Florida Blue and an Independent Licensee of the Blue Cross and Blue Shield Association.GROUP DENTALAnnualized PremiumPer GroupBlue Dental Choice & FreedomGroup & Voluntary (FullyInsured)Blue Dental Care PrepaidGroup & VoluntaryUp to $10,000 10.0% 10%Up to the next $10,000 8.0% 10%Up to the next $10,000 6.0% 10%Up to the next $20,000 4.0% 10%Up to the next $200,000 2.5% 10%Up to the next $250,000 2.0% 10%Up to the next $2,000,000 1.5% 10%Over $2,500,000 1.0% 10%Commissions may be adjusted at renewal or off-anniversary due to factors causing changes in total group revenue.Factors may include but not limited to: additions, cancellations or modification of benefits of any product orfluctuation in enrollment or premium volume.GROUP LIFE AND DISABILITYNumber of EnrolledLivesGroup Life &DisabilityVoluntary Life &Disability4 - 50 15.0% 15%51 - 300 12.0% 15%301 – 500 9.0% 15%500+ 7.0% 15%Florida Blue Agency Agreement 23
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 16 and 17: BlueChoice Copay Plan 714-R1BlueCho
Page 18 and 19: Point Of Service Option 25-R3Point
Page 20 and 21: Addendum B: Agency “Good Standing
Page 24: Addendum D: Operating & Hardware Re

Legal Entity Agency Agreement - Florida Blue - BCBSF

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