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09/22/2015 (2)
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09/22/2015 (2)
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Last modified
11/24/2015 11:08:36 AM
Creation date
11/24/2015 11:08:01 AM
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Meetings
Meeting Type
BCC Regular Meeting
Document Type
Agenda Packet
Meeting Date
09/22/2015
Meeting Body
Board of County Commissioners
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r <br /> M. Reservation of Right to Contract <br /> We reserve the right to contract with any individuals, corporations, associations, partnerships, or other <br /> entities for assistance with the servicing of coverage and benefits to be provided by us or obligations <br /> due, under this Agreement. <br /> N. Service Mark <br /> You, on behalf of the Group and its Covered Retirees, hereby expressly acknowledge your <br /> understanding that this Agreement constitutes a contract solely between you and Florida Blue. We are an <br /> independent corporation operating under a license with the Blue Cross and Blue Shield Association, an <br /> association of independent Blue Cross and Blue Shield Plans, (the "Association") permitting us to use <br /> the Blue Cross and Blue Shield Service Mark in the state of Florida and that we are not contracting as <br /> the agent of the Association. You further acknowledge and agree that you have not entered into this <br /> contract based upon representations by any person other than us and that no person, entity, or <br /> organization other than us shall be held accountable or liable to you for any of our obligations created <br /> under this Agreement. This paragraph shall not create any additional obligations whatsoever on our part <br /> other than those obligations created under other provisions of this Agreement. <br /> O. Third Party Beneficiary <br /> This Agreement was entered into solely and specifically for the benefit of Florida Blue and the Group. <br /> The terms and provisions of the Agreement shall be binding solely upon, and inure solely to the benefit <br /> of, Florida Blue and the Group, and no other person shall have any rights, interest or claims under this <br /> Agreement, including the Evidence of Coverage, or be entitled to sue for a breach thereof as a third- <br /> party beneficiary or otherwise. Florida Blue and the Group hereby specifically express their intent that <br /> health care providers that have not entered into contracts with Florida Blue to participate in Florida <br /> Blue's provider networks shall not be third-party beneficiaries under this Agreement, including the <br /> Evidence of Coverage. <br /> P. Inspection and Audit <br /> You shall permit CMS, The U.S. Department of Health and Human Services, the Comptroller General, <br /> or their designees, to inspect, evaluate, and audit any of your books, contracts, medical records, patient <br /> care documentation, documents, papers, and other records pertaining to coverage by providing records <br /> to Florida Blue, which will submit the records to CMS. This right to inspect, evaluate, and audit shall <br /> extend ten (10) years from the expiration or termination of the Agreement or completion of final audit, <br /> whichever is later, unless otherwise required by applicable law. <br /> Q. Benefit Administrator Guide <br /> We will provide you with a Benefit Administrator Guide, which provides details related to how your <br /> plan is administered and your responsibilities as a benefit administrator. <br /> R. Member Communications and Campaigns <br /> We may send CMS required or Florida Blue member communications without your consent. Samples of <br /> all required materials are available upon request for informational purposes. <br /> I 101 <br />
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