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We may also contact Covered Persons by telephone regarding any Florida Blue campaign and any <br /> campaign approved by the Florida Office of Insurance Regulation and/or CMS, as applicable. We will <br /> notify you of the campaign prior to making contact with members'. <br /> S. COBRA <br /> You are solely responsible for determining when individuals are eligible for coverage under a Medicare <br /> Plan pursuant to the Consolidated Omnibus Budget Reconciliation Act ("COBRA"). You will notify us <br /> promptly of any COBRA elections. For more information on your COBRA responsibilities refer to the <br /> Benefit Administrator Guide. <br /> In consideration of the payment of Premiums when due and subject to all of the terms of this <br /> Agreement, Blue Cross Blue Shield of Florida, Inc. hereby agrees to provide each enrollee of Indian <br /> River County Board of County Commissioners the benefits of this Agreement as set forth in the <br /> attached Evidence of Coverage beginning on each enrollee's effective date. <br /> The Group has selected the following plan and premium: <br /> PPO 1/Rx 1 $319.92 <br /> The Group's Agreement is effective as of 10/1/2015. <br /> IN WITNESS WHEREOF, the parties have executed this Agreement as of<DATE>. <br /> Blue Cross Blue Shield of Florida, Inc. Indian River County Board of County <br /> (DBA Florida Blue) Commissioners <br /> By: By: <br /> (Signature) (Signature) <br /> Name: Lynn Esposito Name: <br /> (Please Print or Type) (Please Print or Type) <br /> Title: Vice President, Sales Operations Title: <br /> APPROVED AS TO FOR <br /> AND LEGAL SUFFI Y <br /> BY <br /> 4Z4REImLn-nin <br /> COUNTY ATTORNEY <br /> 12 102 <br />