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08/16/2016 (4)
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08/16/2016 (4)
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Last modified
10/26/2018 10:57:42 AM
Creation date
10/25/2016 1:02:40 PM
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Meetings
Meeting Type
BCC Regular Meeting
Document Type
Agenda
Meeting Date
08/16/2016
Meeting Body
Board of County Commissioners
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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 />9 167 <br />
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