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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
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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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Shield Association, an association of independent Blue Cross and Blue Shield Plans, (the <br /> "Association") permitting us to use the Blue Cross and Blue Shield Service Mark in the state of <br /> Florida and that we are not contracting as the agent of the Association. You further acknowledge <br /> and agree that you have not entered into this contract based upon representations by any person <br /> other than us and that no person, entity, or organization other than us shall be held accountable or <br /> liable to you for any of our obligations created under this Agreement. This paragraph shall not <br /> create any additional obligations whatsoever on our part other than those obligations created <br /> under other provisions of this Agreement. <br /> O. Third Party Beneficiary <br /> This Agreement was entered into solely and specifically for the benefit of Florida Blue and the <br /> Group. The terms and provisions of the Agreement shall be binding solely upon, and inure solely <br /> to the benefit of, Florida Blue and the Group, and no other person shall have any rights, interest <br /> or claims under this Agreement, including the Evidence of Coverage, or be entitled to sue for a <br /> breach thereof as a third-party beneficiary or otherwise. Florida Blue and the Group hereby <br /> specifically express their intent that health care providers that have not entered into contracts <br /> with Florida Blue to participate in Florida Blue's provider networks shall not be third-party <br /> beneficiaries under this Agreement, including the Evidence of Coverage. <br /> P. Inspection and Audit <br /> You shall permit CMS, The U.S. Department of Health and Human Services, the Comptroller <br /> General, or their designees, to inspect, evaluate, and audit any of your books, contracts, medical <br /> records, patient care documentation, documents, papers, and other records pertaining to coverage <br /> by providing records to Florida Blue, which will submit the records to CMS. This right to <br /> inspect, evaluate, and audit shall extend ten (10) years from the expiration or termination of the <br /> Agreement or completion of final audit, whichever is later, unless otherwise required by <br /> applicable law. <br /> Q. Benefit Administrator Guide <br /> We will provide you with a Benefit Administrator Guide, which provides details related to how <br /> your plan is administered and your responsibilities as a benefit administrator. <br /> R. Member Communications and Campaigns <br /> We may send CMS required or Florida Blue member communications without your consent. <br /> Samples of all required materials are available upon request for informational purposes. <br /> We may also contact Covered Persons by telephone regarding any Florida Blue campaign and <br /> any campaign approved by the Florida Office of Insurance Regulation and/or CMS, as <br /> applicable. We will notify you of the campaign prior to making contact with members. <br /> 12 <br />
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