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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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us. Florida Blue will only adjust the amount due of a Group and will not refund Premium(s) paid to a <br /> Covered Retiree, unless we mutually agree that a Covered Retiree is to be directly billed by Florida <br /> Blue. You must refund to Covered Retirees any amounts received from us that are due to Covered <br /> Retirees in a timely 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") referred to <br /> generally as the "Medicare Advantage Program." When Covered Persons access healthcare services <br /> outside of Florida, the claim for those services will be processed through the Medicare Advantage <br /> Program and presented to us for payment in accordance with the rules of the Medicare Advantage <br /> Program policies then in effect. The Medicare Advantage Program available to Covered Persons under <br /> 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 on <br /> behalf of our Covered Persons, if applicable. The amount negotiated may be either higher than, <br /> 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 be <br /> provided or needed to compute the Premium due. While this coverage is in force, we have the right, at <br /> any reasonable time, to examine your records on any issues necessary to verify information provided by <br /> you. You must retain all records relating to this Agreement, including but not limited to those relating to <br /> LIS administration, for the current calendar year plus an 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 provision <br /> shall be void. We may assign, delegate, or otherwise transfer this Agreement to our successor in interest <br /> 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 benefits be <br /> authorized or approved by us, such authorization or approval shall be considered given when provided in <br /> writing by a duly authorized officer of Florida Blue or his or her designee. <br /> 8 <br />
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