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2017-099A
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2017-099A
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Last modified
11/20/2017 4:23:58 PM
Creation date
10/25/2017 10:48:49 AM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
07/18/2017
Control Number
2017-099A
Agenda Item Number
8.H.
Entity Name
Blue Cross Blue Shield of Florida
Subject
Bluemedicare group master agreement
Medicare Plan coverage
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independent corporation operating under a license with the Blue Cross and Blue Shield Association, an <br /> association of independent Blue Cross and Blue Shield Plans, (the "Association") permitting us to use <br /> the Blue Cross and Blue Shield Service Mark in the state of Florida and that we are not contracting as <br /> the agent of the Association. You further acknowledge and agree that you have not entered into this <br /> contract based upon representations by any person other than us and that no person, entity, or <br /> organization other than us shall be held accountable or liable to you for any of our obligations created <br /> under this Agreement. This paragraph shall not create any additional obligations whatsoever on our part <br /> other than those obligations created under other provisions of this Agreement. <br /> 0. Third Party Beneficiary <br /> This Agreement was entered into solely and specifically for the benefit of Florida Blue and the Group. <br /> The terms and provisions of the Agreement shall be binding solely upon, and inure solely to the benefit <br /> of, Florida Blue and the Group, and no other person shall have any rights, interest or claims under this <br /> Agreement, including the Evidence of Coverage, or be entitled to sue for a breach thereof as a third- <br /> party beneficiary or otherwise. Florida Blue and the Group hereby specifically express their intent that <br /> health care providers that have not entered into contracts with Florida Blue to participate in Florida <br /> Blue's provider networks shall not he third-party beneficiaries under this Agreement, including the <br /> Evidence of Coverage. <br /> P. Inspection and Audit <br /> Unless otherwise prohibited by law, you shall permit CMS, The U.S. Department of Health and Human <br /> Services, the Comptroller General, or their designees, to inspect, evaluate, and audit any of your books, <br /> contracts, medical records, patient care documentation, documents, papers, and other records pertaining <br /> to coverage by providing records to Florida Blue, which will submit the records to CMS. This right to <br /> inspect, evaluate, and audit shall extend ten (10) years from the expiration or termination of the <br /> Agreement or completion of final audit, whichever is later, unless otherwise required by applicable law. <br /> Q. Benefit Administrator Guide <br /> We will provide you with a Benefit Administrator Guide, which provides details related to how your <br /> plan is administered and your responsibilities as a benefit administrator. <br /> R. Member Communications and Campaigns <br /> We may send CMS required or Florida Blue member communications without your consent. Samples of <br /> all required materials are available upon request for informational purposes. <br /> We may also contact Covered Persons by telephone regarding any Florida Blue campaign and any <br /> campaign approved by the Florida Office of Insurance Regulation and/or CMS, as applicable. We will <br /> notify you of the campaign prior to making contact with members. <br /> S. COBRA <br /> You arc solely responsible for determining when individuals are eligible for coverage under a Medicare <br /> Plan pursuant to the Consolidated Omnibus Budget Reconciliation Act ("COBRA"). You will notify us <br /> promptly of any COBRA elections. For more information on your COBRA responsibilities refer to the <br /> Benefit Administrator Guide. <br /> 11 <br />
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