Examples of Setup Form in a sentence
When you elect to have Blue Cross and Blue Shield administer your Account-Based Offerings, Blue Cross and Blue Shield will provide administrative and financial services, either directly or through its designated vendor(s) as described in this Account-Based Offerings Administrative Services Agreement and in the following sections of your Group Setup Form: Customer Service, Covered Person and Account Owner Online Services, and Account Online Services.
Within 45 calendar days prior to your policy year under this Account-Based Offerings Administrative Services Agreement, and then for each subsequent renewal date, you must confirm or revise these designations by submitting (or resubmitting) your completed Group Setup Form to Blue Cross and Blue Shield.
When you elect to have Blue Cross and Blue Shield administer your Account-Based Offerings, Blue Cross and Blue Shield will provide, either directly or through its designated vendor, administrative and financial services in accordance with the Group Setup Form you provide to Blue Cross and Blue Shield for services under this Account-Based Offerings Administrative Services Agreement.
When you elect to use Blue Cross and Blue Shield’s designated vendor(s) to provide certain services for your Account-Based Offerings, you will provide Blue Cross and Blue Shield with a completed Group Setup Form that designates certain aspects of the Account-Based Offerings that you will make available to your eligible employees.
This Account-Based Offerings Administrative Services Agreement will be considered accepted and binding by the parties when you sign your Group Setup Form or, when applicable, your Claim Reimbursement Request Form, or you pay your first month’s service fees for Account-Based Offerings.
Blue Cross and Blue Shield will administer these services in accordance with the terms and conditions of this Account-Based Offerings Administrative Services Agreement, your Group Setup Form and Fee Schedule or, when applicable, your Claim Reimbursement Request Form and Fee Schedule, and the Business Associate Agreement which is included as Attachment 3 to the Premium Account Agreement.
Blue Cross and Blue Shield through its designated vendor(s) will process and adjudicate requests for disbursements for qualified medical expenses in accordance with your Group Setup Form to the extent the Plan design is consistent with Blue Cross and Blue Shield’s designated vendor(s) existing reimbursement platform, and its internal claims review processing standards, which have been established in accordance with industry standards and in compliance with applicable rules and regulations.
Under this Account-Based Offerings Administrative Services Agreement, your general responsibilities are: • Group Setup Form (when applicable to your arrangement with Blue Cross and Blue Shield).
Blue Cross and Blue Shield through its designated vendor(s) will provide the services described in this Section 6 and in the following sections of your Group Setup Form: Claim Files, Online Reimbursement, Explanation of Benefits, Overpayments, FSA Grace Period or FSA Rollover, and Debit Card.
The result of this roll is to be recorded on the Test Setup Form.