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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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Covered Dependent means an Eligible Dependent who continues to meet all applicable <br />eligibility requirements described in the Evidence of Coverage and who is enrolled, and actually <br />covered, under the Agreement other than as a Covered Retiree. <br />Covered Person means a Covered Retiree or a Covered Dependent. <br />Covered Retiree means an Eligible Retiree, who continues to meet all applicable eligibility <br />requirements described in the Evidence of Coverage and who is enrolled, and actually covered, <br />under the Agreement other than as a Covered Dependent. <br />Effective Date for the Group means 12:01 a.m. on the date specified on the last page of this <br />Agreement and for Covered Persons means 12:01 a.m. on the date coverage will begin as <br />specified in the Evidence of Coverage. <br />Eligible Dependent means an individual who meets and continues to meet all of the eligibility <br />requirements described in the Evidence of Coverage. <br />Eligible Retiree means an individual who meets and continues to meet all of the eligibility <br />requirements set forth in the Evidence of Coverage and is eligible to enroll as a Covered Retiree. <br />An Eligible Retiree is not a Covered Retiree until actually enrolled and accepted for coverage as <br />a Covered Retiree by us. <br />Enrollment Forms means those forms, electronic or paper, which are approved by us and used <br />to maintain accurate enrollment files under the Agreement. <br />Grace Period means the sixty (60) calendar day period beginning on the date the Premium is <br />due. <br />Grievance means a type of complaint submitted by a Covered Person (or other person eligible <br />under CMS Requirements to submit a Grievance) about us or one of our network providers or <br />pharmacies, including a complaint concerning the quality of care. This type of complaint does <br />not involve coverage or payment disputes. <br />Group means the employer, labor union, association, partnership, corporation, department, other <br />organization or entity through which coverage and benefits are issued by us. <br />Note: References to "you" or "your" throughout the first part of this Agreement also refer to the <br />Group. References to "you" or "your" in the Evidence of Coverage refer to Eligible Retirees, <br />Eligible Dependents, Covered Retirees and/or Covered Dependents depending on the context and <br />intent of the specific provision. <br />Group Master Agreement or Agreement means the written document which is evidence of the <br />entire agreement between the Group and Florida Blue whereby coverage and benefits are <br />provided to Covered Persons. <br />2 <br />
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