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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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C. Group Disenrollment <br /> If you decide to disenroll all Covered Persons from a Medicare Plan, you must: <br /> 1. Notify all beneficiaries that you intend to disenroll them from the Medicare Plan. You <br /> will provide this notice at least twenty one (21) calendar days before the disenrollment. <br /> This notice will explain how to contact Medicare for information about other plan options <br /> that may be available. You will include language provided by Florida Blue in this notice <br /> to meet specific CMS Requirements for notice contents. <br /> 2. Provide us with all information necessary to submit a complete disenrollment request <br /> transaction to CMS in accordance with CMS Requirements. <br /> 3. In the event of termination of this Agreement, provide advanced notice in accordance <br /> with Section 4 of this Agreement. <br /> D. Individual Covered Person Disenrollment <br /> Covered Persons may be disenrolled from a Medicare Plan by Florida Blue if they become <br /> ineligible for continued enrollment. Covered Persons may also be disenrolled if this Agreement <br /> terminates or if you inform us that they are no longer eligible to participate in your retiree group <br /> health plan. If Florida Blue determines that a Covered Person is ineligible for continued <br /> enrollment or if you instruct us to disenroll an individual, you must: <br /> 1. Provide us with at least thirty (30) calendar days advanced notice of the ineligibility or <br /> disenrollment election of an individual; and <br /> 2. Provide the Covered Person(s) who will be disenrolled with at least twenty one (21) <br /> calendar days advanced notice of the termination and of other insurance options that are <br /> available to them. You will include language provided by Florida Blue in this notice to <br /> meet specific CMS Requirements for notice contents. <br /> The Covered Person will have the opportunity to elect another plan offered by us or by you,join <br /> Original Medicare, or join another carrier's Medicare Plan (by submitting an enrollment request <br /> to that organization). <br /> SECTION 4: TERM AND TERMINATION <br /> A. Term of Agreement and Renewal Process <br /> This Agreement shall become effective as of the Effective Date provided: (1) that we accept your <br /> Group Application; and (2) that you pay the required initial Premium specified by us. <br /> This Agreement shall continue in effect until the first Anniversary Date following the Effective <br /> Date unless terminated earlier as permitted by its terms. After the initial term, this Agreement <br /> shall automatically renew each succeeding year on the Anniversary Date for an additional one- <br /> year period unless: <br /> 4 <br />
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