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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 />