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2015-025D
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2015-025D
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Last modified
4/2/2018 3:40:21 PM
Creation date
4/26/2016 11:52:47 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
02/17/2015
Control Number
2015-025D
Agenda Item Number
8.G.
Entity Name
Blue Cross and Blue Shield of Florida
Subject
Administrative Services Agreement
Financial Arrangements
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E. Grievance and Appeals Process <br />We have established and will maintain a process for hearing and resolving Grievances and <br />Appeals raised by Covered Persons in accordance with CMS requirements. Details regarding this <br />process are provided in the Evidence of Coverage. <br />F. Changes to the Agreement <br />Florida Blue may make any changes to this Agreement that are necessary to meet CMS <br />Requirements ("CMS Mandated Amendments") with sixty (60) calendar days advanced written <br />notice to you. Such changes shall become effective as amendments to this Agreement upon <br />expiration of this sixty (60) calendar day notice period. <br />Except in the case of (a) CMS Mandated Amendments or (b) Renewal Notices as described in <br />Section 4.A., no person may change, modify, or revise the written terms or provisions of this <br />Agreement unless such change is made by a written amendment signed by one of our duly <br />authorized officers. For example, no Eligible Retiree or agent of Florida Blue or the Group can <br />change or waive the written terms or provisions of this Agreement except as stated in the first <br />sentence of this paragraph. <br />G. Furnishing and Maintaining Enrollment Records <br />You must provide any information required by us for the purpose of creating and maintaining <br />enrollment records, processing terminations, and recording changes in family status. In addition, <br />you and each Eligible Retiree must submit accurate and complete Enrollment Forms on a timely <br />basis. You are responsible for collecting the Enrollment Forms, reviewing them for accuracy and <br />completeness, and forwarding them to us, along with the applicable Premium payment. All <br />enrollment record information which is relevant to the eligibility or coverage status of any <br />individual must be made available to us for inspection and copying upon request. <br />H. Errors or Delays <br />Clerical errors or delays by us in maintaining enrollment records regarding Covered Persons will <br />not invalidate coverage which would otherwise be validly in force or continue coverage which <br />would otherwise be validly terminated, provided you have furnished us with timely and accurate <br />enrollment information. Errors or delays by you in furnishing accurate enrollment information to <br />us will not affect our right to strictly enforce any and all eligibility requirements. <br />I. Entire Agreement <br />This Agreement sets forth the exclusive and entire understanding and agreement between the <br />parties and shall be binding upon the Covered Persons, the parties, and any of their subsidiaries, <br />affiliates, successors, heirs, and permitted assigns. All prior negotiations, agreements, and <br />understandings are superseded hereby. No oral statements, representations, or understanding by <br />10 <br />
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