BCBSM. BCN will not permit a group to separate its Medicare and non-Medicare retirees between carriers except when the group offers a BCBSM or BCN group Medicare Advantage plan. Applies to all retiree-only plans and ASC groups.
BCBSM. BCN reserves the right to request a copy of one of the following: Group Health Plan document, Summary Plan Description, Section 125 Cafeteria Plan document or union contract. Document submitted must clearly define retiree eligibility requirements including years of service, age of retirement, and employer contributions amount, surviving spouse options and level of benefits. A letter from Group will not be accepted in lieu of one of these required documents.
BCBSM. BCN, in its sole discretion, may immediately terminate this Agreement with or without cause at any time. BCBSM/BCN shall terminate access to the Company, Principal Administrator, any Delegated Administrator and any Users and BCBSM/BCN shall have no liability in connection with such termination.
BCBSM. The DCC agrees to make available to BCBSM, as the funding agency, data from the MTQIP clinical registry on which to judge participating sites’ participation in the MTQIP clinical registry and quality improvement initiatives. This information may include the timeliness, completeness, and quality of the participating sites data submissions, and their rates of attendance at MTQIP meetings, as well as responsiveness to DCC data queries and to resolving patterns of problems with regard to data validity. The DCC will also provide BCBSM Foundation information regarding the average and range of performance within the collaborative as a whole so that it may assess the extent to which the overall effort is succeeding in improving trauma surgery care. The DCC will not however make available to BCBSM confidential information on the performance of individual sites, other than performance/participation in quality improvement initiatives as part of the annual CQI index measures and scoring report.
BCBSM and BCN shall give Provider sixty (60) days prior written notice of substantial modifications to the Specialty Pharmacy program in accordance with section 3.1 (F). Other changes will be effective with notice.
BCBSM is a major participant in and is familiar with the Minnesota healthcare market and knows of or has developed relationships with healthcare consumers, hospitals, physicians, employers, insurance companies and other healthcare related entities.
BCBSM in its sole discretion, shall have the option to rescind this Agreement in its entirety if BCBSM determines in good faith that the total dollar amount of Relevant Purchases (as defined in the Plan of Allocation) by Settlement Class Members who validly request exclusion materially undermines the value of the Settlement to BCBSM. In the event that Aetna Inc. requests exclusion, BCBSM agrees that it will not include the Relevant Purchases of Aetna Inc. in determining whether the total dollar amount of Relevant Purchases by Settlement Class Members who validly request exclusion materially undermines the value of the Settlement to BCBSM.
