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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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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 <br />CMS Requirements, as applicable. You acknowledge and agree that Premium subsidization may vary <br />for different classes of Eligible Retirees only if such classes are reasonable and based on objective <br />business criteria. You represent and warrant that you will not vary Premium subsidization based on any <br />Covered Person's eligibility for LIS. Further, you will not vary Premium subsidization for individuals <br />within a given class of Eligible Retirees. In no case will you charge an Eligible Retiree more than the <br />sum of the 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 <br />Person's share of Premium. You may not benefit from any LIS amount until the Premium for a <br />Covered Person (including amounts forthe non -drug benefits in a combined Medicare <br />Advantage Prescription Drug Plan) paid by a Covered Retiree is reduced to zero ($0.00). <br />2. You are responsible for reducing up -front Premium contributions that you collect from Covered <br />Retirees for any Covered Persons eligible for LIS. In limited situations where you are unable to <br />reduce the up -front Premium contribution (e.g. if LIS is awarded retroactively), you will directly <br />refund the LIS amount to the Eligible Retiree within fifteen (15) calendar days of the date you <br />receive the LIS amount from Florida Blue. <br />H. Late Enrollment Penalty (LEP) <br />The Premium for an individual Covered Person may be higher if the Covered Person is assessed an LEP <br />for not enrolling in Part B in a timely manner. This higher Premium will be reflected on the bill you <br />receive from us. <br />I. Premium Billing <br />You will be responsible for the payment of the "Total Monthly Premium per Covered Retiree" of all <br />Group members. The Total Monthly Premium may be less for Covered Persons who qualify for LIS as <br />defined by CMS. You will also be responsible for any LEP charges that Group members have been <br />assessed by CMS. The first Premium charge is payable before the Effective Date of this Agreement. <br />Monthly charges are payable on the first day of each following month during the time this Agreement is <br />in effect. <br />7 <br />
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