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2016-113
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Last modified
9/28/2016 11:44:38 AM
Creation date
9/28/2016 11:44:37 AM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
08/16/2016
Control Number
2016-113
Agenda Item Number
8.O.
Entity Name
Blue Cross Blue Shield of Florida
Subject
Master Agreement Renewal healthcare insurance
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F. Premium Subsidization <br /> You may subsidize Premium amounts charged to Eligible Retirees. You are responsible for compliance <br /> with all applicable laws and regulations relating to your subsidy of Premiums, including ERISA and <br /> CMS Requirements, as applicable. You acknowledge and agree that Premium subsidization may vary <br /> for different classes of Eligible Retirees only if such classes are reasonable and based on objective <br /> business criteria. You represent and warrant that you will not vary Premium subsidization based on any <br /> Covered Person's eligibility for LIS. Further, you will not vary Premium subsidization for individuals <br /> within a given class of Eligible Retirees. In no case will you charge an Eligible Retiree more than the <br /> sum of the monthly Premium that we charge you for the Medicare Plan benefits. <br /> G. Low Income Subsidy <br /> You will comply with the following requirements in connection with LIS: <br /> 1. You are required to pass through any LIS payments received from CMS to reduce the Premium <br /> amount that the Covered Retiree pays. You will first apply any LIS amounts to a Covered <br /> Person's share of Premium. You may not benefit from any LIS amount until the Premium for a <br /> Covered Person (including amounts for the non-drug benefits in a combined Medicare <br /> Advantage Prescription Drug Plan)paid by a Covered Retiree is reduced to zero ($0.00). <br /> 2. You are responsible for reducing up-front Premium contributions that you collect from Covered <br /> Retirees for any Covered Persons eligible for LIS. In limited situations where you are unable to <br /> reduce the up-front Premium contribution (e.g. if LIS is awarded retroactively), you will directly <br /> refund the LIS amount to the Eligible Retiree within fifteen (15) calendar days of the date you <br /> 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 an LEP <br /> for not enrolling in Part B in a timely manner. This higher Premium will be reflected on the bill you <br /> receive from us. <br /> I. Premium Billing <br /> You will be responsible for the payment of the "Total Monthly Premium per Covered Retiree" of all <br /> Group members. The Total Monthly Premium may be less for Covered Persons who qualify for LIS as <br /> defined by CMS. You will also be responsible for any LEP charges that Group members have been <br /> assessed by CMS. The first Premium charge is payable before the Effective Date of this Agreement. <br /> Monthly charges are payable on the first day of each following month during the time this Agreement is <br /> in effect. <br /> J. Retroactive Premium Adjustment <br /> The monthly charge will be determined from our records by the number of Covered Retirees who have <br /> been confirmed through the CMS enrollment transaction process. Retroactive adjustments will be made <br /> for additions and terminations of Covered Retirees and for Covered Retirees who have been confirmed <br /> through the CMS enrollment transaction process after the initial billing statement. Any refund that is <br /> owed to a Covered Retiree must come from the Group, unless the Covered Retiree is billed directly by <br /> 7 <br />
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