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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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the Medicare Advantage Program policies then in effect. The Medicare Advantage Program <br /> available to Covered Persons under this Agreement is described generally below. <br /> B. Covered Persons Liability Calculation <br /> The cost of the service on which the Covered Person's liability is based, will be either: <br /> 1. The Medicare allowable amount for covered services; or <br /> 2. The amount we negotiate with the provider of the Host Blue negotiates with its provider <br /> on behalf of our Covered Persons, if applicable. The amount negotiated may be either <br /> higher than, lower than, or equal to the Medicare allowable amount.. <br /> SECTION 7: GENERAL PROVISIONS <br /> A. Administration and Record Retention <br /> You must provide us with any information we need to administer the coverage and/or benefits to <br /> be provided or needed to compute the Premium due. While this coverage is in force, we have the <br /> right, at any reasonable time, to examine your records on any issues necessary to verify <br /> information provided by you. You must retain all records relating to this Agreement, including <br /> but not limited to those relating to LIS administration, for the current calendar year plus an <br /> additional ten (10) years. <br /> B. Assignment and Delegation <br /> You may not assign, delegate or otherwise transfer this Agreement and the obligations hereunder <br /> without our written consent. Any assignment, delegation, or transfer made in violation of this <br /> provision shall be void. We may assign, delegate, or otherwise transfer this Agreement to our <br /> successor in interest or an affiliated entity without your consent at any time. <br /> C. Authorization <br /> Where this Agreement requires that an act involving the administration of coverage and/or <br /> benefits be authorized or approved by us, such authorization or approval shall be considered <br /> given when provided in writing by a duly authorized officer of Florida Blue or his or her <br /> designee. <br /> D. Evidence of Coverage <br /> We will provide an Evidence of Coverage and ID Card for each Covered Retiree. The Evidence <br /> of Coverage will describe the coverage and benefits to be provided to Covered Persons by us. <br /> You agree that, if requested by us, you will distribute the Evidence of Coverage (and any <br /> Endorsements to it) and other coverage materials to Covered Persons. <br /> 9 <br />
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