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2020-137
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2020-137
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Last modified
3/4/2021 3:10:21 PM
Creation date
8/10/2020 10:07:38 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
07/29/2020
Control Number
2020-137
Agenda Item Number
Signed by County Administrator
Entity Name
Florida Blue
Blue Cross and Blue Shield of Florida
Subject
BlueMedicare Group Master Agreement
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BLUEMEDICARE GROUP MASTER AGREEMENT <br />SECTION 1: INTRODUCTION <br />'[his BlueMedicare 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 DruO 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 "Nve "us", "our." and Florida Blue throughout this Agreement refer to Blue Cross and Blue <br />Shield of Florida. Inc. In exchange foryour 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 atter 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 behall' of a Covered Person l:or 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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