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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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any person can change, alter, delete, add or otherwise modify the express written terms of this <br />Agreement, which includes the terms of coverage and/or benefits set forth in the Evidence of <br />Coverage, the Schedule of Benefits, and any other attachments, amendments or riders. <br />J. Financial Responsibilities of the Group <br />We reserve the right to recover any benefit payments made to or on behalf of any individual <br />whose coverage has been terminated. Our recovery efforts may relate to benefit payments made <br />for health care services rendered subsequent to the Covered Person's termination date and prior <br />to the date notice of coverage termination is required to be made by you. Your cooperation with <br />and support such recovery efforts is required. <br />In the event that you do not comply with the notice requirements set forth in Subsection 5.A <br />(Monthly Invoice), you shall be solely liable to us for Premium due until the effective date <br />established by CMS for a Covered Person's disenrollment. <br />'K. Indemnification <br />You shall hold harmless and indemnify Florida Blue, against all claims, demands, liabilities, or <br />expenses (including reasonable attorney fees and court costs), which are related to, arise out of, <br />or are in connection with any of your acts or omissions, or acts or omissions of any of your <br />employees, retirees or agents, in the performance of your obligations under this Agreement. We <br />are not your agent, nor are you our agent, for any purpose. This paragraph shall only apply to the <br />extent allowed under Florida Statutes § 768.28. <br />L. Representations on the Group Application and the Enrollment Forms <br />We rely on the information you and your Eligible Retirees provide to determine whether to issue <br />coverage; the appropriate Premium and financing method; and eligibility for coverage. All such <br />information must be accurate, truthful, and complete. Statements made on the Enrollment Forms <br />are representations and not warranties. <br />We may cancel, terminate, or void this Agreement if the information which you provide is <br />fraudulent, or if you make an intentional misrepresentation. <br />M. Reservation of Right to Contract <br />We reserve the right to contract with any individuals, corporations, associations, partnerships, or <br />other entities for assistance with the servicing of coverage and benefits to be provided by us or <br />obligations 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. <br />We are an independent corporation operating under a license with the Blue Cross and Blue <br />11 <br />
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