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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
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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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combined Medicare Advantage Prescription Drug Plan) paid by a Covered Retiree is <br />reduced to zero ($0.00). <br />2. You are responsible for reducing up -front Premium contributions that you collect from <br />Covered Retirees for any Covered Persons eligible for LIS. In limited situations where <br />you are unable to reduce the up -front Premium contribution (e.g. if LIS is awarded <br />retroactively), you will directly refund the LIS amount to the Eligible Retiree within <br />fifteen (15) calendar days of the date you receive the LIS amount from Florida Blue. <br />H. Late Enrollment Penalty ("LEP") <br />The Premium for an individual Covered Person may be higher if the Covered Person is assessed <br />an LEP for not enrolling in Part B in a timely manner. This higher Premium will be reflected on <br />the bill you receive from us. <br />I. Premium Billing <br />You will be responsible for the payment of the "Total Monthly Premium per Covered Retiree" of <br />all Group members. The Total Monthly Premium may be less for Covered Persons who qualify <br />for LIS as defined by CMS. You will also be responsible for any LEP charges that Group <br />members have been assessed by CMS. The first Premium charge is payable before the Effective <br />Date of this Agreement. Monthly charges are payable on the first day of each following month <br />during the time this Agreement is in effect. <br />J. Retroactive Premium Adjustment <br />The monthly charge will be determined from our records by the number of Covered Retirees <br />who have been confirmed through the CMS enrollment transaction process. Retroactive <br />adjustments will be made for additions and terminations of Covered Retirees and for Covered <br />Retirees who have been confirmed through the CMS enrollment transaction process after the <br />initial billing statement. Any refund that is owed to a Covered Retiree must come from the <br />Group, unless the Covered Retiree is billed directly by us. Florida Blue will only adjust the <br />amount due of a Group and will not refund Premium(s) paid to a Covered Retiree, unless we <br />mutually agree that a Covered Retiree is to be directly billed by Florida Blue. You must refund <br />to Covered Retirees any amounts received from us that are due to Covered Retirees in a timely <br />manner. <br />SECTION 6: HOST BLUE PLANS <br />A. Out of Area Services <br />We have relationships with other Blue Cross and/or Blue Shield Licensees ("Host Blues") <br />referred to generally as the "Medicare Advantage Program." When Covered Persons access <br />healthcare services outside of Florida, the claim for those services will be processed through the <br />Medicare Advantage Program and presented to us for payment in accordance with the rules of <br />8 <br />
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