Laserfiche WebLink
We may also contact Covered Persons by telephone regarding any Florida Blue campaign and any <br />campaign approved by the Florida Office of Insurance Regulation and/or CMS, as applicable. We will <br />notify you of the campaign prior to making contact with members. <br />S. COBRA <br />You are solely responsible for determining when individuals are eligible for coverage under a Medicare <br />Plan pursuant to the Consolidated Omnibus Budget Reconciliation Act ("COBRA"). You will notify us <br />promptly of any COBRA elections. For more information on your COBRA responsibilities refer to the <br />Benefit Administrator Guide. <br />In consideration of the payment of Premiums when due and subject to all of the terms of this <br />Agreement, Blue Cross Blue Shield of Florida, Inc. hereby agrees to provide each enrollee of Indian <br />River County Board of County Commissioners the benefits of this Agreement as set forth in the <br />attached Evidence of Coverage beginning on each enrollee's effective date. <br />The Group has selected the following plan and premium: <br />PPO 1/Rx 1 $319.92 <br />The Group's Agreement is effective as of 10/1/2015. <br />IN WITNESS WHEREOF, the parties have executed this Agreement as of <DATE>. <br />Blue Cross Blue Shield of Florida, Inc. <br />(DBA Florida Blue) <br />By: <br />(Signature) <br />Indian River County Board of County <br />Commissioners <br />13y: • BlaXA <br />Name: Lynn Esposito Name: <br />(Please Print or Type) <br />ature) <br />Jose A . c'1 rd <br />(Please Print or Type) <br />Title: Vice President, Sales Operations Title: C.otem-t foci minisi-r^stor <br />12 <br />APPROVED AS TO FOR <br />AND LEGAL SUFFIihY <br />BY <br />YLAN REINGOLD <br />COUNTY ATTORNEY <br />