1/4/2021 11:21:35 AM
9/19/2018 1:21:19 PM
Official Document Type
Agenda Item Number
Blue Cross and Blue Shield of Florida, Inc.
Blue Medicare Advantage Plan Renewal
BlueMedicare Master Agreement
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F,& <br />B&e 0V <br />In the pursuit of health' <br />BLUEMEDICARE GROUP MASTER AGREEMENT <br />SECTION 1: INTRODUCTION <br />This B1ueMedicare 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 group <br />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 Blue <br />Shield of Florida, Inc. In exchange for your payment of the Premium, we agree to provide the coverage <br />and/or benefits specified in the Evidence of Coverage for the Medicare Plan(s) ("Evidence of Coverage"), <br />a copy of which is attached to this Agreement. The coverage to be provided by us under the Group Plan <br />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 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 the <br />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 requirements <br />described in the Evidence of Coverage and who is enrolled, and actually covered, under the Agreement <br />other than as a Covered Dependent. <br />
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