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SECTION 3: ELIGIBILITY, ENROLLMENT,AND DISENROLLMENT <br /> A. Eligibility Determination <br /> Determination of whether an individual is an Eligible Retiree or Eligible Dependent will be a two-step <br /> process: <br /> 1. You will determine whether the individual is eligible to participate in the retiree group health <br /> benefit plan that you sponsor. For individuals meeting your eligibility criteria, you will promptly <br /> forward completed applications to us. You are responsible for complying with all applicable laws <br /> and regulations, including but not limited to the Employee Retirement Income Security Act <br /> (ERISA) and the Internal Revenue Code, in making this eligibility determination. You must also <br /> comply with all eligibility guidelines included in the benefit administrative guide and Evidence <br /> of Coverage. <br /> 2. After receiving a complete application, we will process the application in accordance with CMS <br /> Requirements. An application must be approved by us and accepted by CMS for an individual to <br /> be enrolled in a Medicare Plan. <br /> B. Distribution of Enrollment Materials <br /> You may only distribute materials describing the Medicare Plan that we have provided to you or that we <br /> have approved in writing. You will distribute any pre-enrollment materials that we provide to you to <br /> each potential enrollee before collecting enrollment applications. Nothing in this Section will preclude <br /> you from making additional disclosures about your group health benefit plan as applicable to comply <br /> with ERISA, such as a wrap-around summary plan description or other plan document. If applicable, <br /> you are solely responsible for compliance with ERISA disclosure requirements in connection with the <br /> Medicare Plan(s). <br /> C. Group Disenrollment <br /> If you decide to disenroll all Covered Persons from a Medicare Plan, you must: <br /> 1. Notify all beneficiaries that you intend to disenroll them from the Medicare Plan. You will <br /> provide this notice at least twenty one (21) calendar days before the disenrollment. This notice <br /> will explain how to contact Medicare for information about other plan options that may be <br /> available. You will include language provided by Florida Blue in this notice to meet specific <br /> CMS Requirements for notice contents. <br /> 2. Provide us with all information necessary to submit a complete disenrollment request transaction <br /> to CMS in accordance with CMS Requirements. <br /> 3. In the event of termination of this Agreement, provide advanced notice in accordance with <br /> Section 4 of this Agreement. <br /> D. Individual Covered Person Disenrollment <br /> Covered Persons may be disenrolled from a Medicare Plan by Florida Blue if they become ineligible for <br /> continued enrollment. Covered Persons may also be disenrolled if this Agreement terminates or if you <br /> 3 <br />