Services included and buy-up options (ABF) Zoe Center for Pediatric and Adolescent Health LLC
Effective June 1, 2025 through May 31, 2026
Services Included in fixed administrative costs Administration of the proposed 1500 Ded Plan~Blue Open Access POS, 3000 Ded Plan~Blue Open Access POS plan designs. Anthem Health Guide ABF Foundational Program
FI Engagement Package 700 EAP Basic 3-Visit Diabetes Prevention Outreach Blue Distinction Programs Claims Fiduciary Coverage
Standard ID cards
Standard management reporting State/federal reporting Open enrollment meeting support Electronic version of the benefit booklets
Implementation/Plan Program/Other Credit - Annual credit in the amount of $15,000.00 will be applied towards services from Anthem and Non-Anthem pre-approved services. This credit is applicable only during the 6/1/2025 through 5/31/2026 policy year and will be forfeited if not used by the end of the policy year 5/31/2026. If Zoe Center for Pediatric and Adolescent Health LLC terminates this agreement prior to the end of the agreement period, the Plan Program Credit amount shall be prorated. If Zoe Center for Pediatric and Adolescent Health LLC has received credits greater than the prorated amount, then Zoe Center for Pediatric and Adolescent Health LLC shall also be responsible for returning excess credit amounts to Empire within 30 days of the termination.
NOTE: Expenses for items such as programming, personnel expenses, travel and incentives are not reimbursable. Buy-Up Options
PCPM fee
EAP Enhanced 4-Visit EAP Enhanced 6-Visit
$1.27
$1.76 Fee Billed Per Participant Per Month
Spending Account & Other Buy-up Options (charged separately)
Anthem Spending Accounts Stand Alone, Commuter, or Dependent Care FSA
$3.55 $0.80 $0.80 $1.15 $1.25
Multi-Purse Add-on: Primary HRA required Multi-Purse Add-on: Primary HRA required, Wrap Model Multi-Purse Add-on: Primary HSA required, Employer Pay Multi-Purse Add-on: Primary HSA required, Member Pay
Notes Full quote details available upon request. HSA and HRA account administration is only available with particular plan designs. Details available upon request. Health Savings Account Fees may be paid by the employer or the employee.
0546032-03
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