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2016-113
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D. Evidence of Coverage <br /> We will provide an Evidence of Coverage and ID Card for each Covered Retiree. The Evidence of <br /> 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 Endorsements <br /> to it) and other coverage materials to Covered Persons. <br /> E. Grievance and Appeals Process <br /> We have established and will maintain a process for hearing and resolving Grievances and Appeals <br /> raised by Covered Persons in accordance with CMS requirements. Details regarding this process are <br /> provided in the Evidence of Coverage. <br /> F. Changes to the Agreement <br /> Florida Blue may make any changes to this Agreement that are necessary to meet CMS Requirements <br /> ("CMS Mandated Amendments") with sixty (60) calendar days advanced written notice to you. Such <br /> changes shall become effective as amendments to this Agreement upon expiration of this sixty (60) <br /> calendar day notice period. <br /> Except in the case of(a) CMS Mandated Amendments or (b) Renewal Notices as described in Section <br /> 4.A., no person may change, modify, or revise the written terms or provisions of this Agreement unless <br /> such change is made by a written amendment signed by one of our duly authorized officers. For <br /> example, no Eligible Retiree or agent of Florida Blue or the Group can change or waive the written <br /> terms or provisions of this Agreement except as stated in the first sentence of this paragraph. <br /> G. Furnishing and Maintaining Enrollment Records <br /> You must provide any information required by us for the purpose of creating and maintaining <br /> enrollment records, processing terminations, and recording changes in family status. In addition, you <br /> and each Eligible Retiree must submit accurate and complete Enrollment Forms on a timely basis. You <br /> are responsible for collecting the Enrollment Forms, reviewing them for accuracy and completeness, and <br /> forwarding them to us, along with the applicable Premium payment. All enrollment record information <br /> which is relevant to the eligibility or coverage status of any individual must be made available to us for <br /> inspection and copying upon request. <br /> H. Errors or Delays <br /> Clerical errors or delays by us in maintaining enrollment records regarding Covered Persons will not <br /> invalidate coverage which would otherwise be validly in force or continue coverage which would <br /> otherwise be validly terminated, provided you have furnished us with timely and accurate enrollment <br /> information. Errors or delays by you in furnishing accurate enrollment information to us will not affect <br /> our right to strictly enforce any and all eligibility requirements. <br /> I. Entire Agreement <br /> This Agreement sets forth the exclusive and entire understanding and agreement between the parties and <br /> shall be binding upon the Covered Persons, the parties, and any of their subsidiaries, affiliates, <br /> 9 <br />
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