My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2021-123
CBCC
>
Official Documents
>
2020's
>
2021
>
2021-123
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
9/9/2021 12:21:34 PM
Creation date
9/7/2021 2:16:03 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
08/17/2021
Control Number
2021-123
Agenda Item Number
8.AP.
Entity Name
Blue Cross and Blue Shield of Florida, Inc. (Florida Blue)
Subject
Renewal of the Blue Medicare Advanced Platinum PPO plan
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
12
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />J.R. SMITH, CLERK <br />invoice unless a signed application form is on file and submitted to Florida Blue. Payment shall be for the <br />total amount of the Group invoice. <br />B. Payment Due Date <br />The first Premium payment is due before the Effective Date of the Agreement. Each following payment <br />is due monthly unless you agree with us in writing on some other method and/or frequency of payment. <br />The Premium is due and payable on or before the first day of each succeeding calendar month to which <br />such payments apply. <br />C. Grace Period <br />This Agreement has a sixty (60) calendar day Premium payment Grace Period, which begins on the date <br />the Premium payment is due. If we do not receive the required Premium payment on or before the date it <br />is due, it may be paid during this Grace Period. Coverage will stay in force during the Grace Period. If <br />Premium payments are not received by the end of the Grace Period, we will terminate this Agreement and <br />proceed with the disenrollment of Covered Persons as described in Section 3 of this Agreement. <br />D. Changes in Premium <br />Premium rates may be changed on your Anniversary Date as described in Section 4.A above regarding <br />renewal. <br />E. Other Rules Regarding the Payment of Premiums <br />1. CMS rules govern the effective date of any disenrollment of a Covered Person under this <br />Agreement, and we are not required to retroactively terminate this Agreement or coverage for any <br />Covered Person. <br />2. If full payment of the Premium is not paid when due, this Agreement may be terminated as <br />described in Section 4 of this Agreement. <br />F. Premium Subsidization <br />You may subsidize Premium amounts charged to Eligible Retirees. You are responsible for compliance <br />with all applicable laws and regulations relating to your subsidy of Premiums, including ERISA and CMS <br />Requirements, as applicable. You acknowledge and agree that Premium subsidization may vary for <br />different classes of Eligible Retirees only if such classes are reasonable and based on objective business <br />criteria. You represent and warrant that you will not vary Premium subsidization based on any Covered <br />Person's eligibility for LIS. Further, you will not vary Premium subsidization for individuals within a <br />given class of Eligible Retirees. In no case will you charge an Eligible Retiree more than the sum of the <br />monthly Premium that we charge you for the Medicare Plan benefits. <br />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 />2 <br />
The URL can be used to link to this page
Your browser does not support the video tag.