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2022-149A
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2022-149A
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Last modified
5/26/2023 10:33:49 AM
Creation date
5/26/2023 10:32:28 AM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
08/16/2022
Control Number
2022-149A
Agenda Item Number
8.Z.
Entity Name
Blue Cross Blue Shield of Florida, Inc.
Subject
BlueMedicare Group Master Agreement Renewal
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Effective Date for the Group means 12:01 a.m. on the date specified on the last page of this Agreement <br />and for Covered Persons means 12:01 a.m. on the date coverage will begin as specified in the Evidence <br />of Coverage. <br />Eligible Dependent means an individual who meets and continues to meet all of the eligibility <br />requirements described in the Evidence of Coverage. <br />Eligible Retiree means an individual who meets and continues to meet all of the eligibility requirements <br />set forth in the Evidence of Coverage and is eligible to enroll as a Covered Retiree. An Eligible Retiree is <br />not a Covered Retiree until actually enrolled and accepted for coverage as a Covered Retiree by us. <br />Enrollment Forms means those forms, electronic orpaper, which are approved by us and used to maintain <br />accurate enrollment files under the Agreement. <br />Grace Period means the sixty (60) calendar day period beginning on the date the Premium is due. <br />Grievance means a type of complaint submitted by a Covered Person (or other person eligible under CMS <br />Requirements to submit a Grievance) about us or one of our network providers or pharmacies, including <br />a complaint concerning the quality of care. This type of complaint does not involve coverage or payment <br />disputes. <br />Group means the employer, labor union, association, partnership, corporation, department, other <br />organization or entity through which coverage and benefits are issued by us. <br />Note: References to "you" or "your" throughout the first part of this Agreement also refer to the Group. <br />References to "you" or "your" in the Evidence of Coverage refer to Eligible Retirees, Eligible Dependents, <br />Covered Retirees and/or Covered Dependents depending on the context and intent of the specific <br />provision. <br />Group Master Agreement or Agreement means the written document which is evidence of the entire <br />agreement between the Group and Florida Blue whereby coverage and benefits are provided to Covered <br />Persons. <br />Late Enrollment Penalty ("LEP") means an amount added to the Part D Premium of an individual who <br />did not have Part D coverage or other creditable prescription drug plan when the individual first became <br />eligible for Part D or who had a break in Part D or other creditable prescription drug coverage for at least <br />63 days. <br />Low Income Subsidy ("LIS") means the premium subsidy amount paid to us by CMS for qualifying <br />Covered Persons with Medicare Part D coverage. <br />Medicare Plan means the group Medicare Advantage Plan, Medicare Advantage Prescription Drug Plan, <br />and/or standalone Medicare Prescription Drug Plan that you select. <br />Premium means the amount required to be paid by the Group to us for coverage under this Agreement. <br />Service Area means a geographic area where a Medicare Plan accepts members. <br />N <br />
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