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2015-025E
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2015-025E
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Last modified
4/26/2016 1:20:46 PM
Creation date
4/26/2016 1:19:49 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
02/17/2015
Control Number
2015-025E
Agenda Item Number
8.I
Entity Name
BlueMedicare Group Florida Blue
Subject
Master Agreement
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Fl�rid� �- <br /> AW <br /> Ar,1 dependent Lkemee or the <br /> 9je cross and 81oe s c*w Ammimio., <br /> BLUEMEDICARE GROUP MASTER AGREEMENT <br /> SECTION 1: INTRODUCTION <br /> This B1ueMedicare Group Master Agreement (this "Agreement") describes the rights and <br /> obligations which you and Blue Cross and Blue Shield of Florida, Inc. ("Florida Blue") have <br /> with respect to the group Medicare Advantage, Medicare Advantage Prescription Drug Plan, <br /> and/or standalone Medicare Prescription Drug Plan (hereinafter, "Medicare Plan(s)") coverage to <br /> be provided by us to your Covered Retirees and Covered Dependents. <br /> References to "we", "us", "our," and Florida Blue throughout this Agreement refer to Blue Cross <br /> and Blue Shield of Florida, Inc. In exchange for your payment of the Premium, we agree to <br /> provide the coverage and/or benefits specified in the Evidence of Coverage for the Medicare <br /> Plan(s) ("Evidence of Coverage"), a copy of which is attached to this Agreement. The coverage <br /> to be provided by us under the Group Plan which you have established is described in the <br /> Evidence of Coverage. <br /> SECTION 2: DEFINITIONS <br /> Certain terms defined in the Agreement are also used and defined (for the convenience of <br /> Covered Persons) in the Evidence of Coverage. If a word or phrase starts with a capital letter, it <br /> is either the first word in a sentence, a proper name, a title, or a defined term. The following <br /> defined terms apply to this Agreement: <br /> Anniversary Date means the date one year after the Effective Date of coverage and subsequent <br /> annual anniversaries or such other date as mutually agreed to in writing by the parties. <br /> Appeal means a request submitted by or on behalf of a Covered Person for a review of our <br /> decision to deny a request for coverage of health care services or prescription drugs or payment <br /> for services or drugs. <br /> CMS means the Centers for Medicare and Medicaid Services. <br /> CMS Requirements means the provisions of Parts C and D of Title XVIII of the Social Security <br /> Act, CMS Medicare Part C and D regulations at 42 C.F.R. Parts 422 and 423, the CMS Managed <br /> Care and Prescription Drug Benefit Manuals, other CMS instructions and guidance and the <br /> provisions of Florida Blue's contracts with CMS to offer the Medicare Plans. <br />
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