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f <br /> D. Individual Covered Person Disenrollment <br /> Covered Persons may be disenrolled from a Medicare Plan by Florida Blue if they become ineligible for <br /> continued enrollment. Covered Persons may also be disenrolled if this Agreement terminates or if you <br /> inform us that they are no longer eligible to participate in your retiree group health plan. If Florida Blue <br /> determines that a Covered Person is ineligible for continued enrollment or if you instruct us to disenroll <br /> an individual, you must: <br /> 1. Provide us with at least thirty (30) calendar days advanced notice of the ineligibility or <br /> disenrollment election of an individual; and <br /> 2. Provide the Covered Person(s) who will be disenrolled with at least twenty one (21) calendar <br /> days advanced notice of the termination and of other insurance options that are available to them. <br /> You will include language provided by Florida Blue in this notice to meet specific CMS <br /> Requirements for notice contents. <br /> The Covered Person will have the opportunity to elect another plan offered by us or by you, join <br /> Original Medicare, or join another carrier's Medicare Plan (by submitting an enrollment request to that <br /> organization). <br /> SECTION 4: TERM AND TERMINATION <br /> A. Term of Agreement and Renewal Process <br /> This Agreement shall become effective as of the Effective Date provided: (1) that we accept your Group <br /> Application; and (2) that you pay the required initial Premium specified by us. <br /> This Agreement shall continue in effect until the first Anniversary Date following the Effective Date <br /> unless terminated earlier as permitted by its terms. After the initial term, this Agreement shall <br /> automatically renew each succeeding year on the Anniversary Date for an additional one-year period <br /> unless: <br /> 1. At least sixty (60) calendar days prior to such Anniversary Date, you notify us that you do not <br /> want the Agreement to automatically renew; or <br /> 2. It is terminated as permitted by its terms. <br /> At least ninety (90) calendar days before each Anniversary Date, we will provide you with notice of <br /> changes in Premium and benefits under the Medicare Plan for the upcoming year (the "Renewal <br /> Notice"). <br /> If this Agreement renews as specified above, all of its terms and provisions (including the Premium due) <br /> shall be amended to include the terms of the Renewal Notice, and the amended Agreement shall govern <br /> coverage as of the Anniversary Date. Payment of the new charges shall constitute acceptance of the <br /> change in Premium rates. This Agreement is conditionally renewable. This means that it automatically <br /> renews each year on your Anniversary Date unless terminated earlier in accordance with its terms. <br /> 4 94 <br />