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S. COBRA <br />You are solely responsible for determining when individuals are eligible for coverage under a <br />Medicare Plan pursuant to the Consolidated Omnibus Budget Reconciliation Act ("COBRA"). <br />You will notify us promptly of any COBRA elections. For more information on your COBRA <br />responsibilities refer to the Benefit Administrator Guide. <br />In consideration of the payment of Premiums when due and subject to all of the terms of this <br />Agreement, Blue Cross Blue Shield of Florida, Inc. hereby agrees to provide each enrollee of <br />Indian River County BOCC the benefits of this Agreement as set forth in the attached <br />Evidence of Coverage beginning on each enrollee's effective date. <br />The Group has selected the following plan and premium: <br />BlueMedicare Group <br />PPO*Plan 1 ---$379.99 <br />The Group's Agreement is effective as of October 1, 2014. <br />IN WITNESS WHEREOF, the parties have executed this Agreement as of <br />Blue Cross Blue Shield of Florida, Inc. Indian River County BOCC <br />By: <br />(Signature) <br />Name: <br />Title: <br />Lynn Esposito <br />By: <br />(Signature) <br />Name: <br />(Please Print or Type) <br />Vice President, Sales Operations Title: <br />13 <br />(Please Print or Type) <br />APPROVED AS TO FORM <br />AND LEGAL SUFFICIENCY <br />BY <br />DYLAN REINGOLD <br />OOUNTY ATTORNEY <br />100 <br />