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Last modified
1/4/2021 11:21:35 AM
Creation date
9/19/2018 1:21:19 PM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
09/11/2018
Control Number
2018-170
Agenda Item Number
8.AA.
Entity Name
Blue Cross and Blue Shield of Florida, Inc.
Florida Blue
Subject
Blue Medicare Advantage Plan Renewal
BlueMedicare Master Agreement
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G. Low Income Subsidy <br />You will comply with the following requirements in connection with LIS: <br />1. You are required to pass through any LIS payments received from CMS to reduce the Premium <br />amount that the Covered Retiree pays. You will first apply any LIS amounts to a Covered Person's <br />share of Premium. You may not benefit from any LIS amount until the Premium for a Covered <br />Person (including amounts for the non -drug benefits in a combined Medicare Advantage <br />Prescription Drug Plan) paid by a Covered Retiree is reduced to zero ($0.00). <br />2. You are responsible for reducing up -front Premium contributions that you collect from Covered <br />Retirees for any Covered Persons eligible for LIS. In limited situations where you are unable to <br />reduce the up -front Premium contribution (e.g. if LIS is awarded retroactively), you will directly <br />refund the LIS amount to the Eligible Retiree within fifteen (15) calendar days of the date you <br />receive the LIS amount from Florida Blue. <br />H. Late Enrollment Penalty (LEP) <br />The Premium for an individual Covered Person may be higher if the Covered Person is assessed an LEP <br />for not enrolling in Part B in a timely manner. This higher Premium will be reflected on the bill you receive <br />from us. <br />I. Premium Billing <br />You will be responsible for the payment of the "Total Monthly Premium per Covered Retiree" of all Group <br />members. The Total Monthly Premium may be less for Covered Persons who qualify for LIS as defined <br />by CMS. You will also be responsible for any LEP charges that Group members have been assessed by <br />CMS. The first Premium charge is payable before the Effective Date of this Agreement. Monthly charges <br />are payable on the first day of each following month during the time this Agreement is in effect. <br />J. Retroactive Premium Adjustment <br />The monthly charge will be determined from our records by the number of Covered Retirees who have <br />been confirmed through the CMS enrollment transaction process. Retroactive adjustments will be made <br />for additions and terminations of Covered Retirees and for Covered Retirees who have been confirmed <br />through the CMS enrollment transaction process after the initial billing statement. Any refund that is owed <br />to a Covered Retiree must come from the Group, unless the Covered Retiree is billed directly by us. <br />Florida Blue will only adjust the amount due of a Group and will not refund Premium(s) paid to a Covered <br />Retiree, unless we mutually agree that a Covered Retiree is to be directly billed by Florida Blue. You must <br />refund to Covered Retirees any amounts received from us that are due to Covered Retirees in a timely <br />manner. <br />SECTION 6: HOST BLUE PLANS <br />A. Out -of -Area Services — Medicare Advantage <br />We have relationships with other Blue Cross and/or Blue Shield Licensees ("Host Blues") referred to <br />generally as the "Inter -Plan Medicare Advantage Program." This Program operates under rules and <br />procedures issued by the Blue Cross Blue Shield Association ("Association"). When members access <br />7 <br />
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