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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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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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