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2015-185
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Last modified
3/30/2017 4:46:27 PM
Creation date
10/8/2015 2:33:17 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
09/22/2015
Control Number
2015-185
Agenda Item Number
8.L
Entity Name
Bluemedicare Group
Florida Blue
Blue Cross and Blue Shield
Subject
Master Agreement
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M. Reservation of Right to Contract <br />We reserve the right to contract with any individuals, corporations, associations, partnerships, or other <br />entities for assistance with the servicing of coverage and benefits to be provided by us or obligations <br />due, under this Agreement. <br />N. Service Mark <br />You, on behalf of the Group and its Covered Retirees, hereby expressly acknowledge your <br />understanding that this Agreement constitutes a contract solely between you and Florida Blue. We are an <br />independent corporation operating under a licensee with the Blue Cross and Blue Shield Association, an <br />association of independent Blue Cross and Blue Shield Plans, (the "Association") permitting us to use <br />the Blue Cross and Blue Shield Service Mark in the state of Florida and that we are not contracting as <br />the agent of the Association. You further acknowledge and agree that you have not entered into this <br />contract based upon representations by any person other than us and that no person, entity, or <br />organization other than us shall be held accountable or liable to you for any of our obligations created <br />under this Agreement. This paragraph shall not create any additional obligations whatsoever on our part <br />other than those obligations created under other provisions of this Agreement. <br />0. Third Party Beneficiary <br />This Agreement was entered into solely and specifically for the benefit of Florida Blue and the Group. <br />The terms and provisions of the Agreement shall be binding solely upon, and inure solely to the benefit _ <br />of, Florida Blue and the Group, and no other person shall have any rights, interest or claims under this <br />Agreement, including the Evidence of Coverage, or be entitled to sue for a breach thereof as a third - <br />party beneficiary or otherwise. Florida Blue and the Group hereby specifically express their intent that <br />health care providers that have not entered into contracts with Florida Blue to participate in Florida <br />Blue's provider networks shall not be third -party beneficiaries under this Agreement, including the <br />Evidence of Coverage. <br />P. Inspection and Audit <br />You shall permit CMS, The U.S. Department of Health and Human Services, the Comptroller General, <br />or their designees, to inspect, evaluate, and audit any of your books, contracts, medical records, patient <br />care documentation, documents, papers, and other records pertaining to coverage by providing records <br />to, Florida Blue, which will submit the records to CMS. This right to inspect, evaluate, and audit shall <br />extend ten (10) years from the expiration or termination of the Agreement or completion of final audit, <br />whichever is later, unless otherwise required by applicable law. <br />Q. Benefit Administrator Guide <br />We will provide you with a Benefit Administrator Guide, which provides details related to how your <br />plan is administered and your responsibilities as a benefit administrator. <br />R. Member Communications and Campaigns <br />We may send CMS required or Florida Blue member communications without your consent. Samples of <br />all required materials are available upon request for informational purposes. <br />11 <br />
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