11/20/2017 4:23:58 PM
10/25/2017 10:48:49 AM
Official Document Type
Agenda Item Number
Blue Cross Blue Shield of Florida
Bluemedicare group master agreement
Medicare Plan coverage
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Florida <br /> Blue <br /> In the pursuit of health' <br /> BLUEMEDICARE GROUP MASTER AGREEMENT <br /> SECTION 1: INTRODUCTION <br /> This BlueMedicare Group Master Agreement (this "Agreement") describes the rights and obligations <br /> which you and Blue Cross and Blue Shield of Florida, Inc. ("Florida Blue") have with respect to the <br /> group Medicare Advantage, Medicare Advantage Prescription Drug Plan, and/or standalone Medicare <br /> Prescription Drug Plan (hereinafter, "Medicare Plan(s)") coverage to be provided by us to your Covered <br /> Retirees and Covered Dependents. <br /> References to "we", "us", "our," and Florida Blue throughout this Agreement refer to Blue Cross and <br /> Blue Shield of Florida, Inc. In exchange for your payment of the Premium, we agree to provide the <br /> coverage and/or benefits specified in the Evidence of Coverage for the Medicare Plan(s) ("Evidence of <br /> Coverage"), a copy of which is attached to this Agreement. The coverage to be provided by us under the <br /> Group Plan which you have established is described in the Evidence of Coverage. <br /> SECTION 2: DEFINITIONS <br /> Certain terms defined in the Agreement are also used and defined (for the convenience of Covered <br /> Persons) in the Evidence of Coverage. If a word or phrase starts with a capital letter, it is either the first <br /> word in a sentence, a proper name, a title, or a defined term. The following defined terms apply to this <br /> Agreement: <br /> Anniversary Date means the date one year after the Effective Date of coverage and subsequent annual <br /> anniversaries or such other date as mutually agreed to in writing by the parties. <br /> Appeal means a request submitted by or on behalf of a Covered Person for a review of our decision to <br /> deny a request for coverage of health care services or prescription drugs or payment for services or <br /> drugs. <br /> CMS means the Centers for Medicare and Medicaid Services. <br /> CMS Requirements means the provisions of Parts C and D of Title XVIII of the Social Security Act, <br /> CMS Medicare Part C and D regulations at 42 C.F.R. Parts 422 and 423, the CMS Managed Care and <br /> Prescription Drug Benefit Manuals, other CMS instructions and guidance and the provisions of Florida <br /> Blue's contracts with CMS to offer the Medicare Plans. <br /> Covered Dependent means an Eligible Dependent who continues to meet all applicable eligibility <br /> requirements described in the Evidence of Coverage and who is enrolled, and actually covered, under <br /> the Agreement other than as a Covered Retiree. <br /> Covered Person means a Covered Retiree or a Covered Dependent. <br /> Covered Retiree means an Eligible Retiree, who continues to meet all applicable eligibility <br /> requirements described in the Evidence of Coverage and who is enrolled, and actually covered, under <br /> the Agreement other than as a Covered Dependent. <br />
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