Common use of CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION Clause in Contracts

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing necessary information or refusal to provide in- formation reasonably needed may result in the delay or denial of benefits until the necessary in- formation is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your individually identifiable personal and health infor- mationinformation, including Protected Health Information. Personal and health Individually identifiable personal information includes both medical health, financial, and/or demographic information and individually identifi- able information, - such as your name, address, tele- phone number, or and social security number. Blue Shield will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD'S ’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain ” can be obtained either by calling the Customer Service Department at the telephone number indicated on your Identification Cardlisted in the back of this Evidence of Coverage, or by accessing Blue Shield of CaliforniaShield’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx xxx.xxxxxxxxxxxx.xxx and printing a copy. If you Members who are concerned that Blue Shield may have vi- olated your confidentiality/violated their privacy rights, or you who disagree with a decision we Blue Shield made about access to your their individually identifiable personal and health information, you may contact us Blue Shield at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxOffice P.O. Box 272540 Chico, XX 00000CA 95927-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx 2540 Blue Shield may need information from medical providers, from other carriers or other entities, or from youthe Member, in order to administer benefits the Benefits and eligi- bility eligibility provisions of this Agreement. You agree By enrolling in this health plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You Members also agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your the Member’s possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits Benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. Legal process or service upon Blue Shield must be served upon Blue Shield’s Registered Agent for Service of Process or upon Blue Shield at Blue Shield’s corporate offices at 00 Xxxxx Xxxxxx, San Francisco, California 94105. Many residents in the state of California are eligible to become organ and tissue donors. Donors can affect the well-being of one or more of the estimated 100,000 people in the United States of America who must face death daily while waiting for an organ transplant. One person on this list dies about every three hours – all the while waiting for an organ or tissue donation. For more information on organ and tissue donation, or to register as a donor, visit the California Transplant Doctor Network’s internet site at xxx.xxxx.xxx or Donate Life California’s internet site at xxx.xxxxxxxxxxxxxxxxxxxx.xxx. Potential donors can also call the regional organ procurement agency in the nearest city nearest for additional information on organ and tissue donation.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able individu- ally identifiable information, such as your name, address, tele- phone telephone number, or social security numberSocial Security Number. Blue Shield of California will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S SHIELD OF CALIFORNIA’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s Shield of California's policies and procedures regarding our confidentiality/privacy practices are contained in the “"Notice of Privacy Practices”", which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, listed in the back of this booklet or by accessing Blue Shield of California’s internet 's Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield of California may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield of California that information that is reasonably needed by Blue ShieldShield of California. You agree to assist Blue Shield of California in obtaining this informationinfor- mation, if needed, (including signing any necessary authorizationsauthori- zations) and to cooperate by providing Blue Shield of Cali- fornia with information in your possession. Failure to assist Blue Shield of California in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result re- xxxx in the delay or denial of benefits until the necessary in- formation is received. Any information received for this purpose pur- pose by Blue Shield of California will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidenti- ality/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able identi- fiable information, such as your name, address, tele- phone telephone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access ac- cess to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility xxx- gibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate co- operate by providing Blue Shield with information infor- mation in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal re- fusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information infor- mation received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise other- wise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your individually identifiable personal and health infor- mationinformation, including Protected Health Information. Personal and health Individually identifiable personal information includes both medical health, financial, and/or demographic information and individually identifi- able information, - such as your name, address, tele- phone number, or and social security number. Blue Shield will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD'S ’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain ” can be obtained either by calling the Customer Service Department at the telephone number indicated on your Identification Cardlisted in the back of this Evidence of Coverage, or by accessing Blue Shield of CaliforniaShield’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx xxx.xxxxxxxxxxxx.xxx and printing a copy. If you Members who are concerned that Blue Shield may have vi- olated your confidentiality/violated their privacy rights, or you who disagree with a decision we Blue Shield made about access to your their individually identifiable personal and health information, you may contact us Blue Shield at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxOffice P.O. Box 272540 Chico, XX 00000CA 95927-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx 2540 Blue Shield may need information from medical providers, from other carriers or other entities, or from youthe Member, in order to administer benefits the Benefits and eligi- bility eligibility provisions of this Agreement. You agree By enrolling in this health plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You Members also agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your the Member’s possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits Benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. Legal process or service upon Blue Shield must be served upon Blue Shield’s Registered Agent for Service of Process or upon Blue Shield at Blue Shield’s corporate offices at 00 Xxxxx Xxxxxx, San Francisco, California 94105. Many residents in the state of California are eligible to become organ and tissue donors. Donors can affect the well-being of one or more of the estimated 100,000 people in the United States of America who must face death daily while waiting for an organ transplant. One person on this list dies about every three hours – all the while Benefits provided after the effective date of any change will be subject to the change. There is no vested right to obtain Benefits. waiting for an organ or tissue donation. For more information on organ and tissue donation, or to register as a donor, visit the California Transplant Doctor Network’s internet site at xxx.xxxx.xxx or Donate Life California’s internet site at xxx.xxxxxxxxxxxxxxxxxxxx.xxx. Potential donors can also call the regional organ procurement agency in the nearest city nearest for additional information on organ and tissue donation.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your individually identifiable personal and health infor- mationinformation, including Pro- tected Health Information. Personal and health Individually identifi- able personal information includes both medical health, xxxxx- cial, and/or demographic information and individually identifi- able information, such as your name, address, tele- phone number, or and social security number. Blue Shield will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTRE- QUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain ” can be obtained either by calling the Customer Service Department at the telephone number indicated on your Identification Cardlisted in the back of this EOC, or by accessing ac- cessing Blue Shield of CaliforniaShield’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx xxx.xxxxxxxxxxxx.xxx and printing a copy. If you Members who are concerned that Blue Shield may have vi- olated your confidentiality/violated their privacy rights, or you who disagree with a decision we Blue Shield made about access to your their individually identifiable personal and health informationinforma- tion, you may contact us Blue Shield at: Blue Shield of California Privacy Official Xxxxxx X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from youthe Member, in order to administer benefits the Ben- efits and eligi- bility eligibility provisions of this AgreementContract. You agree By enrolling in this Health Plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You Members also agree to assist Blue Shield in obtaining this information, if needed, (including in- cluding signing any necessary authorizations) and to cooperate by providing Blue Shield with information infor- mation in your the Member’s possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation reasonably information rea- sonably needed may result in the delay or denial of benefits Benefits until the necessary in- formation information is receivedre- ceived. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your individually iden- tifiable personal and health infor- mationinformation, including Protected Health Information. Personal and health Individually identifiable per- xxxxx information includes both medical health, financial, and/or demographic information and individually identifi- able information, such as your name, address, tele- phone number, or and social security number. Blue Shield will not disclose this information without your authorization, except as permitted per- mitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING PRESERV- ING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED FUR- NISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain ” can be obtained either by calling the Customer Service Department Shield Concierge at the telephone number indicated on your Identification Cardlisted in the back of this EOC, or by accessing access- ing Blue Shield of CaliforniaShield’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx xxx.xxxxxxxxxxxx.xxx and printing a copy. If you Members who are concerned that Blue Shield may have vi- olated your confidentiality/violated their privacy rights, or you who disagree with a decision we Blue Shield made about access to your their individually identifiable personal and health information, you may contact us Blue Shield at: Blue Shield of California Privacy Official Xxxxxx X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from youthe Member, in order to administer benefits the Benefits and eligi- bility eligibility provisions of this AgreementContract. You agree By en- rolling in this health plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You Members also agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate xxxxxx- ate by providing Blue Shield with information in your their possession. Failure to assist Blue Shield in obtain- ing ob- taining necessary information or refusal to provide in- formation information reasonably needed may result in the delay xx- xxx or denial of benefits Benefits until the necessary in- formation informa- tion is received. Any information received for this purpose by Blue Shield will be maintained as confidential confi- dential and will not be disclosed without your consent, except ex- cept as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation, including your medical records, claims and personal information. Personal and health information includes both medical information and individually identifi- able identifiable information, such as your name, address, tele- phone telephone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTstatement describing Blue Shield's policies and procedures for preserving the confidentiality of medical records is available and will be furnished to you upon request. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your individually identifiable personal and health infor- mationinformation, including Protected Health Information. Personal and health Individually identifiable personal information includes both medical health, financial, and/or demographic information and individually identifi- able information, - such as your name, address, tele- phone number, or and social security number. Blue Shield will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD'S ’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain ” can be obtained either by calling the Customer Service Department at the telephone number indicated on your Identification Cardlisted in the back of this Evidence of Coverage, or by accessing Blue Shield of CaliforniaShield’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx xxx.xxxxxxxxxxxx.xxx and printing a copy. If you Members who are concerned that Blue Shield may have vi- olated your confidentiality/violated their privacy rights, or you who disagree with a decision we Blue Shield made about access to your their individually identifiable personal and health information, you may contact us Blue Shield at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxOffice P.O. Box 272540 Chico, XX 00000CA 95927-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx 2540 Blue Shield may need information from medical providers, from other carriers or other entities, or from youthe Member, in order to administer benefits the Benefits and eligi- bility eligibility provisions of this Agreement. You agree By enrolling in this health plan, each Member agrees that any provider or entity can person on this list dies about every three hours – all the while waiting for an organ or tissue donation. For more information on organ and tissue donation, or to register as a donor, visit the California Transplant Doctor Network’s internet site at xxx.xxxx.xxx or Donate Life California’s internet site at xxx.xxxxxxxxxxxxxxxxxxxx.xxx. Potential donors can also call the regional organ procurement agency in the nearest city nearest for additional information on organ and tissue donation. disclose to Blue Shield that information that is reasonably needed by Blue Shield. You Members also agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your the Member’s possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits Benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.as

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing necessary information or refusal to provide in- formation reasonably needed may result in the delay or denial of benefits until the necessary in- formation is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidenti- ality/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able identi- fiable information, such as your name, address, tele- phone telephone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access ac- cess to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility xxx- gibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate co- operate by providing Blue Shield with information infor- mation in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal re- fusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information infor- mation received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise other- wise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidenti- ality/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able identi- fiable information, such as your name, address, tele- phone telephone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access ac- cess to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility xxx- gibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate co- operate by providing Blue Shield with information infor- mation in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal re- fusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information infor- mation received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise other- wise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidenti- ality/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able identi- fiable information, such as your name, address, tele- phone telephone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access ac- cess to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility xxx- gibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including includ- ing signing any necessary authorizations) and to cooperate by providing Blue Shield with information infor- mation in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal re- fusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information in- formation received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able individu- ally identifiable information, such as your name, address, tele- phone telephone number, or social security numberSocial Security Number. Blue Shield of California will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S SHIELD OF CALIFORNIA’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s Shield of California's policies and procedures regarding our confidentiality/privacy practices are contained in the “"Notice of Privacy Practices”", which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, listed in the back of this booklet or by accessing Blue Shield of California’s internet 's Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield of California may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield of California that information that is reasonably needed by Blue ShieldShield of California. You agree to assist Blue Shield of California in obtaining this informationinfor- mation, if needed, (including signing any necessary authorizationsauthori- zations) and to cooperate by providing Blue Shield of Cali- fornia with information in your possession. Failure to assist Blue Shield of California in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result re- xxxx in the delay or denial of benefits until the necessary in- formation is received. Any information received for this purpose pur- pose by Blue Shield of California will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. Legal process or service upon Blue Shield of California must be served upon a corporate officer of Blue Shield of Califor- nia. Many residents in the state of California are eligible to be- come organ and tissue donors. By deciding to be an organ and tissue donor, you can affect the well-being of one or more of the estimated 100,000 people in the United States of America who must face death daily while waiting for an or- gan transplant. One person on this list dies about every three hours – all the while waiting for an organ or tissue donation. For more information on organ and tissue donation, or to register as a donor, visit the California Transplant Doctor Network’s internet site at xxxx://xxx.xxxx.xxx or Donate Life California’s internet site at xxxx://xxx.xxxxxxxxxxxxxxxxxxxx.xxx. You may also call the regional organ procurement agency in the city nearest you for additional information on organ and tissue donation. A Member may select any Hospital or Physician to provide covered Services hereunder, including providers outside of California. Benefits differ depending on whether a Preferred Provider or a Non-Preferred Provider is selected. It is to the Member's advantage to select Preferred Providers whenever possible. See the section entitled DEFINITIONS for addi- tional information. A Directory of Preferred Physicians and Preferred Hospitals has been provided to the Subscriber. A listing of Blue Shield of California Preferred Physicians and Preferred Hospitals may be viewed by accessing Blue Shield of California's Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx. An extra copy is available upon request by calling Blue Shield of California Customer Service Department at the telephone number indicated on your Identification card, or writing to: If the inability to perform by a Preferred Provider, the breach of the contract to furnish Services by a Preferred Provider, or the termination of a Preferred Provider's contract with Blue Shield of California may materially and adversely affect the Member, Blue Shield of California will, within a reasonable time, advise the Member in writing of such inability to per- form, breach, or termination. This Agreement, including the appendices, constitutes the entire agreement between parties. Any statement made by a Member shall, in the absence of fraud, be deemed a represen- tation and not a warranty. No change in this Agreement shall be valid unless approved by a corporate officer of Blue Shield of California and a written endorsement issued. No representative has authority to change this Agreement or to waive any of its provisions. Blue Shield of California will provide at least 60 days written notice of any changes to this Agreement. Attached to and incorporated in this Agreement by reference are appendices pertaining to Deductibles and dues. En- dorsements may be issued from time to time subject to the notice provisions in the section entitled Duration of the Agreement. Nothing contained in any endorsement shall affect this Agreement, except as expressly provided in the endorsement.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able individu- ally identifiable information, such as your name, address, tele- phone telephone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTRE- QUEST. Blue Shield’s policies and procedures regarding our confidentialityconfidenti- ality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Member Services Department at the telephone number indicated provided on your Identification Cardthe last page of this booklet, or by accessing Blue Shield of California’s internet Inter- net site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health informationinfor- mation, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx ACCESS TO INFORMATION Blue Shield of California may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this AgreementContract. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizationsau- thorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. NON-ASSIGNABILITY Benefits of this Plan are not assignable. PLEASE READ THE FOLLOWING INFORMATION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy confidentiality / pri- vacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able identifiable information, such as your name, address, tele- phone telephone number, or social security number. Blue Shield of California will not disclose this information without with- out your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S SHIELD OF CALIFORNIA’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue ShieldShield of California’s policies and procedures regarding regard- ing our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Cardlisted in the back of this booklet, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield of California may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal per- xxxxx and health information, you may contact us at: P.O. Box 272540 Chico, CA 00000-0000 Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical medi- cal providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility provisions eligibility provi- sions of this Agreement. You agree that any provider or entity en- tity can disclose to Blue Shield of California that information infor- mation that is reasonably needed by Blue ShieldShield of California. You agree to assist Blue Shield of California in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield of California with information in your possessionposses- sion. Failure to assist Blue Shield of California in obtain- ing obtaining necessary information or refusal to provide in- formation reasonably information rea- sonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information infor- mation received for this purpose by Blue Shield of Califor- nia will be maintained as confidential and will not be disclosed dis- closed without your consent, except as otherwise permitted by law. Legal process or service upon Blue Shield of California must be served upon a corporate officer of Blue Shield of California. Many residents in the state of California are eligible to be- come organ and tissue donors. By deciding to be an organ and tissue donor, you can affect the well-being of one or more of the estimated 100,000 people in the United States of America who must face death daily while waiting for an organ transplant. One person on this list dies about every three hours – all the while waiting for an organ or tissue do- nation. For more information on organ and tissue donation, or to register as a donor, visit the California Transplant Doctor Network’s internet site at xxxx://xxx.xxxx.xxx or Donate Life California’s internet site at xxxx://xxx.xxxxxxxxxxxxxxxxxxxx.xxx. You may also call the regional organ procurement agency in the city nearest you for additional information on organ and tissue donation. A Member may select any Hospital or Physician to provide covered Services hereunder, including providers outside of California. Benefits differ depending on whether a Pre- ferred Provider or a non-Preferred Provider is selected. It is to the Member's advantage to select Preferred Providers whenever possible. A Directory of Preferred Physicians and Preferred Hospitals has been provided to the subscriber. An extra copy is avail- able upon request by calling Blue Shield of California’s Customer Service Department at the telephone number indi- cated on your Identification Card or writing to: Blue Shield of California P.O. Box 7168 San Francisco, CA 94120-7168 If the inability to perform by a Preferred Provider, the breach of the contract to furnish Services by a Preferred Provider, or the termination of a Preferred Provider's con- tract with Blue Shield of California may materially and ad- versely affect the Member, Blue Shield of California will, within a reasonable time, advise the Member in writing of such inability to perform, breach, or termination. This Agreement, including the appendices, constitutes the entire agreement between parties. Any statement made by a Member shall, in the absence of fraud, be deemed a repre- sentation and not a warranty. No change in this Agreement shall be valid unless approved by a corporate officer of Blue Shield of California and a written endorsement issued. No representative has authority to change this Agreement or to waive any of its provisions. Blue Shield of California will provide at least 60 days written notice of any changes to this Agreement. Attached to and incorporated in this Agreement by reference are appendices pertaining to Deductibles and dues. En- dorsements may be issued from time to time subject to the notice provisions of the section entitled Duration of the Agreement. Nothing contained in any endorsement shall af- fect this Agreement, except as expressly provided in the en- dorsement.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate coop- erate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing ob- taining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiali- ty/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical med- ical information and individually identifi- able informationidentifiable in- formation, such as your name, address, tele- phone telephone number, or social security number. Blue Shield will not disclose this information without your authorizationau- thorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTstatement describing Blue Shield's policies and procedures for preserving the confidentiality of medical records is available and will be fur- nished to you upon request. Blue Shield’s policies poli- cies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Ser- vice Department at the telephone number indicated indi- cated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access ac- cess to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits bene- fits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiali- ty/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able identifiable information, such as your name, address, tele- phone telephone number, or social security number. Blue Shield will not disclose this information without your authorizationau- thorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTstatement describing Blue Shield's policies and procedures for preserving the confidentiality of medical records is available and will be furnished to you upon request. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield of California that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including in- cluding signing any necessary authorizations) and to cooperate by providing Blue Shield of with information in- formation in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information infor- mation received for this purpose by Blue Shield of will be maintained as confidential and will not be disclosed without your consent, except as otherwise other- wise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. P.X. Xxx 000000 Xxxxx, XX 00000-0000 TollXoll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing necessary information or refusal to provide in- formation reasonably needed may result in the delay or denial of benefits until the necessary in- formation is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able individu- ally identifiable information, such as your name, address, tele- phone tel- ephone number, or social security number. Blue Shield will not disclose this information without your authorization, except ex- cept as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S ’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentialityconfiden- tiality/privacy practices are contained in the “Notice of Privacy Xxxxx- cy Practices”, which you may obtain either by calling the Customer Service Department Member Services at the telephone number indicated on your Identification Cardlisted in the back of this booklet, or by accessing Blue Shield of California’s internet Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health informationinfor- mation, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx XxxxXxxxxxxx_Xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield of California may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose dis- close to Blue Shield of California that information that is reasonably rea- sonably needed by Blue ShieldShield of California. You agree to assist Blue Shield of California in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield of California with information in your possession. Failure to assist Blue Shield of California in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay xx- xxx or denial of benefits until the necessary in- formation information is receivedre- ceived. Any information received for this purpose by Blue Shield of California will be maintained as confidential and will not be disclosed without your consent, except as otherwise other- wise permitted by law.. This procedure enables you to participate in establishing pub- lic policy of Blue Shield of California. It is not to be used as a substitute for the grievance procedure, complaints, inquiries, or requests for information. Public policy means acts performed by a plan or its employ- ees and staff to assure the comfort, dignity, and convenience of patients who rely on the plan’s facilities to provide health care services to them, their families, and the public (Health and Safety Code, Section 1369). At least one third of the Board of Directors of Blue Shield is comprised of Subscribers who are not employees, providers, subcontractors or group contract brokers and who do not have financial interests in Blue Shield. The names of the members of the Board of Directors may be obtained from:

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidenti- ality/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able identi- fiable information, such as your name, address, tele- phone telephone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTstatement describing Blue Shield's policies and procedures for preserving the confidentiality of medical records is available and will be furnished to you upon request. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling call- ing the Customer Service Department at the telephone tele- phone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access ac- cess to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility xxx- gibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including includ- ing signing any necessary authorizations) and to cooperate by providing Blue Shield with information infor- mation in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal re- fusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information in- formation received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. flect decisions on public policy issues that were considered. If you have initiated a policy issue, appropriate extracts of the minutes will be furnished to you within ten (10) business days after the minutes have been approved.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your individually identifiable personal and health infor- mationinformation, including Pro- tected Health Information. Personal and health Individually identifi- able personal information includes both medical health, xxxxx- cial, and/or demographic information and individually identifi- able information, such as your name, address, tele- phone number, or and social security number. Blue Shield will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTRE- QUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain ” can be obtained either by calling the Customer Service Department at the telephone number indicated on your Identification Cardlisted in the back of this EOC, or by accessing ac- cessing Blue Shield of CaliforniaShield’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx xxx.xxxxxxxxxxxx.xxx and printing a copy. If you Members who are concerned that Blue Shield may have vi- olated your confidentiality/violated their privacy rights, or you who disagree with a decision we Blue Shield made about access to your their individually identifiable personal and health informationinforma- tion, you may contact us Blue Shield at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxOffice P.O. Box 272540 Chico, XX 00000CA 95927-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx 2540 Blue Shield may need information from medical providers, from other carriers or other entities, or from youthe Member, in order to administer benefits the Ben- efits and eligi- bility eligibility provisions of this AgreementContract. You agree By enrolling in this Health Plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You Members also agree to assist Blue Xxxx Shield in obtaining this information, if needed, (including in- cluding signing any necessary authorizations) and to cooperate by providing Blue Shield with information infor- mation in your the Member’s possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation reasonably information rea- sonably needed may result in the delay or denial of benefits Benefits until the necessary in- formation information is receivedre- ceived. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. Grievance Process Blue Shield has established a grievance procedure days following any incident or action that is the subject of the Member’s dissatisfaction. Members can request an expedited decision when the routine decision making process might seriously jeopardize the life or health of a Member, or when the Member is experiencing severe pain. Blue Shield shall make a decision and notify the Member and Physician as soon as possible to accommodate the Member’s condition not to exceed 72 hours following the receipt of the request. An expedited decision may involve admissions, continued stay, or other healthcare services. For additional information regarding the expedited decision process, or to request an expedited decision be made for a particular issue, please contact Customer Service. for receiving, resolving and tracking Members’ grievances with Blue Shield.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidenti- ality/privacy of your personal and health infor- mation, including your medical records, claims and personal information. Personal and health information in- formation includes both medical information and individually identifi- able identifiable information, such as your name, address, tele- phone telephone number, or social security secu- rity number. Blue Shield will not disclose this information in- formation without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTstatement describing Blue Shield's policies and procedures for preserving the confidentiality of medical records is available and will be furnished to you upon request. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access ac- cess to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility xxx- gibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including includ- ing signing any necessary authorizations) and to cooperate by providing Blue Shield with information infor- mation in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal re- fusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information in- formation received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfiden- tiality/privacy of your personal and health infor- mationin- formation. Personal and health information includes both medical information and individually identifi- able individu- ally identifiable information, such as your name, address, tele- phone telephone number, or social security numbernum- ber. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTstatement describing Blue Shield's policies and procedures for preserving the confidentiality of medical records is available and will be furnished to you upon request. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll-Free Telephone:0000 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Mail to:xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing ob- taining necessary information or refusal to provide in- formation pro- vide information reasonably needed may result in the delay or denial of benefits until the necessary in- formation neces- sary information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed dis- closed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidenti- ality/privacy of your personal and health infor- mation, including your medical records, claims and personal information. Personal and health information in- formation includes both medical information and individually identifi- able identifiable information, such as your name, address, tele- phone telephone number, or social security secu- rity number. Blue Shield will not disclose this information in- formation without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTstatement describing Blue Shield's policies and procedures for preserving the confidentiality of medical records is available and will be furnished to you upon request. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling call- ing the Customer Service Department at the telephone tele- phone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access ac- cess to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility xxx- gibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including includ- ing signing any necessary authorizations) and to cooperate by providing Blue Shield with information infor- mation in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal re- fusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information in- formation received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your individually identifiable personal and health infor- mationinformation, including Protected Health Information. Personal and health Individually identifiable personal information includes both medical health, financial, and/or demographic information and individually identifi- able information, - such as your name, address, tele- phone number, or and social security number. Blue Shield will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD'S ’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain ” can be obtained either by calling the Customer Service Department at the telephone number indicated on your Identification Cardlisted in the back of this Evidence of Coverage, or by accessing Blue Shield of CaliforniaShield’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx xxx.xxxxxxxxxxxx.xxx and printing a copy. If you Members who are concerned that Blue Shield may have vi- olated your confidentiality/violated their privacy rights, or you who disagree with a decision we Blue Shield made about access to your their individually identifiable personal and health information, you may contact us Blue Shield at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxOffice P.O. Box 272540 Chico, XX 00000CA 95927-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx 2540 Blue Shield may need information from medical providers, from other carriers or other entities, or from youthe Member, in order to administer benefits the Benefits and eligi- bility eligibility provisions of this Agreement. You agree By enrolling in this health plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You Members also agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your the Member’s possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits Benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. Legal process or service upon Blue Shield must be served upon Blue Shield’s Registered Agent for Service of Process or upon Blue Shield at Blue Shield’s corporate offices at 00 Xxxxx Xxxxxx, San Francisco, California 94105. Many residents in the state of California are eligible to become organ and tissue donors. Donors can affect the well-being of one or more of the estimated 100,000 people in the United States of America who must face death daily while services by a Participating Provider, or the termination of a Participating Provider's contract with Blue Shield materially and adversely affects the Member, Blue Shield will, within a reasonable time, advise the Member in writing of such inability to perform, breach, or termination. This Agreement, including the appendices, constitutes the entire agreement between parties. Any statement made by a Member shall, in the absence of fraud, be deemed a representation and not a warranty. No change in this Agreement shall be valid unless approved by a corporate officer of Blue Shield and a written endorsement issued. No representative has authority to change this Agreement or to waive any of its provisions. The terms of this Agreement, including but not limited to Benefits, Deductibles, Copayments, Coinsurance, Out-of-Pocket Maximums and Premiums are subject to change at any time. Blue Shield will provide at least 60 days written notice of changes relating to premium rates or coverage. Benefits provided after the effective date of any change will be subject to the change. There is no vested right to obtain Benefits. waiting for an organ transplant. One person on this list dies about every three hours – all the while waiting for an organ or tissue donation. For more information on organ and tissue donation, or to register as a donor, visit the California Transplant Doctor Network’s internet site at xxx.xxxx.xxx or Donate Life California’s internet site at xxx.xxxxxxxxxxxxxxxxxxxx.xxx. Potential donors can also call the regional organ procurement agency in the nearest city nearest for additional information on organ and tissue donation.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx P. ACCESS TO INFORMATION Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.law.‌

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your individually identifiable personal and health infor- mationinformation, including Pro- tected Health Information. Personal and health Individually identifi- able personal information includes both medical health, xxxxx- cial, and/or demographic information and individually identifi- able information, such as your name, address, tele- phone number, or and social security number. Blue Shield will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTRE- QUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain ” can be obtained either by calling the Customer Service Department at the telephone number indicated on your Identification Cardlisted in the back of this EOC, or by accessing ac- cessing Blue Shield of CaliforniaShield’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx xxx.xxxxxxxxxxxx.xxx and printing a copy. If you Members who are concerned that Blue Shield may have vi- olated your confidentiality/violated their privacy rights, or you who disagree with a decision we Blue Shield made about access to your their individually identifiable personal and health informationinforma- tion, you may contact us Blue Shield at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxOffice P.O. Box 272540 Chico, XX 00000CA 95927-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx 2540 Blue Shield may need information from medical providers, from other carriers or other entities, or from youthe Member, in order to administer benefits the Ben- efits and eligi- bility eligibility provisions of this AgreementContract. You agree By enrolling in this Health Plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You Members also agree to assist Blue Shield in obtaining this information, if needed, (including in- cluding signing any necessary authorizations) and to cooperate by providing Blue Shield with information infor- mation in your the Member’s possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation reasonably information rea- sonably needed may result in the delay or denial of benefits Benefits until the necessary in- formation information is receivedre- ceived. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. Grievance Process Blue Shield has established a grievance procedure for receiving, resolving and tracking Members’ grievances with Blue Shield.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able identifiable information, such as your name, address, tele- phone number, telephone number or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTstatement describing Blue Shield’s policies and procedures for preserving the confidentiality of medical records is available and will be furnished to you upon request. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able individu- ally identifiable information, such as your name, address, tele- phone telephone number, or social security numberSocial Security Number. Blue Shield of California will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S SHIELD OF CALIFORNIA’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s Shield of California's policies and procedures regarding our confidentiality/privacy practices are contained in the “"Notice of Privacy Practices”", which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, listed in the back of this booklet or by accessing Blue Shield of California’s internet 's Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield of California may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield of California that information that is reasonably needed by Blue ShieldShield of California. You agree to assist Blue Shield of California in obtaining this informationinfor- mation, if needed, (including signing any necessary authorizationsauthori- zations) and to cooperate by providing Blue Shield of Cali- fornia with information in your possession. Failure to assist Blue Shield of California in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result re- xxxx in the delay or denial of benefits until the necessary in- formation is received. Any information received for this purpose pur- pose by Blue Shield of California will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. Legal process or service upon Blue Shield of California must be served upon a corporate officer of Blue Shield of Califor- nia. Many residents in the state of California are eligible to be- come organ and tissue donors. By deciding to be an organ and tissue donor, you can affect the well-being of one or more of the estimated 100,000 people in the United States of America who must face death daily while waiting for an or- gan transplant. One person on this list dies about every three hours – all the while waiting for an organ or tissue donation. For more information on organ and tissue donation, or to register as a donor, visit the California Transplant Doctor Network’s internet site at xxxx://xxx.xxxx.xxx or Donate Life California’s internet site at xxxx://xxx.xxxxxxxxxxxxxxxxxxxx.xxx. You may also call the regional organ procurement agency in the city nearest you for additional information on organ and tissue donation. A Member may select any Hospital or Physician to provide covered Services hereunder, including providers outside of California. Benefits differ depending on whether a Preferred Provider or a Non-Preferred Provider is selected. It is to the Member's advantage to select Preferred Providers whenever possible. See the section entitled Definitions for additional information. A Directory of Preferred Physicians and Pre- ferred Hospitals has been provided to the Subscriber. A list- ing of Blue Shield of California Preferred Physicians and Preferred Hospitals may be viewed by accessing Blue Shield of California's Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx. An extra copy is available upon request by calling Blue Shield of California at the tele- phone number indicated on your Identification Card, or writ- ing to: If the inability to perform by a Preferred Provider, the breach of the contract to furnish Services by a Preferred Provider, or the termination of a Preferred Provider's contract with Blue Shield of California may materially and adversely affect the Member, Blue Shield of California will, within a reasonable time, advise the Member in writing of such inability to per- form, breach, or termination. This Agreement, including the appendices, constitutes the entire agreement between parties. Any statement made by a Member shall, in the absence of fraud, be deemed a represen- tation and not a warranty. No change in this Agreement shall be valid unless approved by a corporate officer of Blue Shield of California and a written endorsement issued. No representative has authority to change this Agreement or to waive any of its provisions. Blue Shield of California will provide at least 60 days written notice of any changes to this Agreement. Attached to and incorporated in this Agreement by reference are appendices pertaining to Deductibles and dues. En- dorsements may be issued from time to time subject to the notice provisions in the section entitled Duration of the Agreement. Nothing contained in any endorsement shall affect this Agreement, except as expressly provided in the endorsement.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able individual- ly identifiable information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except ex- cept as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING PRE- SERVING THE CONFIDENTIALITY OF MEDICAL MED- ICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentialityconfidenti- ality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Member Services Department at the telephone number indicated provided on your Identification Cardthe last page of this booklet, or by accessing Blue Shield of California’s internet Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health informationinfor- mation, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx ACCESS TO INFORMATION Blue Shield of California may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this AgreementContract. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizationsau- thorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. NON-ASSIGNABILITY Benefits of this Plan are not assignable. PLEASE READ THE FOLLOWING INFORMATION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- : 0-000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx P. ACCESS TO INFORMATION Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your individually identifiable personal and health infor- mationinformation, including Protected Health Information. Personal and health Individually identifiable personal information includes both medical health, financial, and/or demographic information and individually identifi- able information, - such as your name, address, tele- phone number, or and social security number. Blue Shield will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD'S ’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain ” can be obtained either by calling the Customer Service Department at the telephone number indicated on your Identification Cardlisted in the back of this Evidence of Coverage, or by accessing Blue Shield of CaliforniaShield’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx xxx.xxxxxxxxxxxx.xxx and printing a copy. If you Members who are concerned that Blue Shield may have vi- olated your confidentiality/violated their privacy rights, or you who disagree with a decision we Blue Shield made about access to your their individually identifiable personal and health information, you may contact us Blue Shield at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxOffice P.O. Box 272540 Chico, XX 00000CA 95927-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx 2540 Blue Shield may need information from medical providers, from other carriers or other entities, or from youthe Member, in order to administer benefits the Benefits and eligi- bility eligibility provisions of this Agreement. You agree By enrolling in this health plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You Members also agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your the Member’s possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits Benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. Legal process or service upon Blue Shield must be served officer of Blue Shield and a written endorsement issued. No representative has authority to change this Agreement or to waive any of its provisions. The terms of this Agreement, including but not limited to Benefits, Deductibles, Copayments, Coinsurance, Out-of-Pocket Maximums and Premiums are subject to change at any time. Blue Shield will provide at least 60 days written notice of changes relating to premium rates or coverage. Benefits provided after the effective date of any change will be subject to the change. There is no vested right to obtain Benefits. upon Blue Shield’s Registered Agent for Service of Process or upon Blue Shield at Blue Shield’s corporate offices at 00 Xxxxx Xxxxxx, San Francisco, California 94105. Many residents in the state of California are eligible to become organ and tissue donors. Donors can affect the well-being of one or more of the estimated 100,000 people in the United States of America who must face death daily while waiting for an organ transplant. One person on this list dies about every three hours – all the while waiting for an organ or tissue donation. For more information on organ and tissue donation, or to register as a donor, visit the California Transplant Doctor Network’s internet site at xxx.xxxx.xxx or Donate Life California’s internet site at xxx.xxxxxxxxxxxxxxxxxxxx.xxx. Potential donors can also call the regional organ procurement agency in the nearest city nearest for additional information on organ and tissue donation.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidenti- ality/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able identi- fiable information, such as your name, address, tele- phone telephone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTstatement describing Blue Shield's policies and procedures for preserving the confidentiality of medical records is available and will be furnished to you upon request. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access ac- cess to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility xxx- gibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including includ- ing signing any necessary authorizations) and to cooperate by providing Blue Shield with information infor- mation in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal re- fusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information in- formation received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your individually iden- tifiable personal and health infor- mationinformation, including Protected Health Information. Personal and health Individually identifiable per- xxxxx information includes both medical health, financial, and/or demographic information and individually identifi- able information, such as your name, address, tele- phone number, or and social security number. Blue Shield will not disclose this information without your authorization, except as permitted per- mitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING PRESERV- ING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED FUR- NISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain ” can be obtained either by calling the Customer Service Department at the telephone number indicated on your Identification Cardlisted in the back of this EOC, or by accessing access- ing Blue Shield of CaliforniaShield’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx xxx.xxxxxxxxxxxx.xxx and printing a copy. If you Members who are concerned that Blue Shield may have vi- olated your confidentiality/violated their privacy rights, or you who disagree with a decision we Blue Shield made about access to your their individually identifiable personal and health information, you may contact us Blue Shield at: Blue Shield of California Privacy Official Xxxxxx X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from youthe Member, in order to administer benefits the Benefits and eligi- bility eligibility provisions of this AgreementContract. You agree By en- rolling in this health plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You Members also agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate xxxxxx- ate by providing Blue Shield with information in your their possession. Failure to assist Blue Shield in obtain- ing ob- taining necessary information or refusal to provide in- formation information reasonably needed may result in the delay xx- xxx or denial of benefits Benefits until the necessary in- formation informa- tion is received. Any information received for this purpose by Blue Shield will be maintained as confidential confi- dential and will not be disclosed without your consent, except ex- cept as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able individu- ally identifiable information, such as your name, address, tele- phone number, or social security numberSocial Security Number. Blue Shield of California will not disclose this information without your authorizationau- thorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S SHIELD OF CALIFORNIA’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s Shield of California's policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice "No- xxxx of Privacy Practices”", which you may obtain either by calling call- ing the Customer Service Department at the telephone number indicated on your Identification Card, listed in the back of this booklet or by accessing Blue Shield of California’s internet Califor- nia's Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield of California may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield of California that information that is reasonably needed by Blue ShieldShield of California. You agree to assist Blue Shield of California in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate coop- erate by providing Blue Shield of California with information in your possession. Failure to assist Blue Shield of California in obtain- ing obtaining necessary information or refusal to provide in- formation infor- mation reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information in- formation received for this purpose by Blue Shield of Califor- nia will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. This procedure enables you to participate in establishing public policy of Blue Shield of California. It is not to be used as a substitute for the grievance procedure complaints, inquiries or requests for information. Public policy means acts performed by a plan or its employees and staff to assure the comfort, dignity, and convenience of patients who rely on the plan's facilities to provide health care services to them, their families, and the public (Health and Safety Code, Section 1369). At least one third of the Board of Directors of Blue Shield of California is comprised of Subscribers who are not employees, providers, subcontractors or group contract brokers and who do not have financial interests in Blue Shield of California. The names of the members of the Board of Directors may be obtained from: Your recommendations, suggestions, or comments should be submitted in writing to the Sr. Manager, Regulatory Filings, at the above address, who will acknowledge receipt of your letter. Your name, address, phone number, Subscriber number, and group number should be included with each communication. The policy issue should be stated so that it will be readily un- derstood. Submit all relevant information and reasons for the policy issue with your letter. Policy issues will be heard at least quarterly as agenda items for meetings of the Board of Directors. Minutes of Board meetings will reflect decisions on public policy issues that were considered. If you have initiated a policy issue, appro- priate extracts of the minutes will be furnished to you within ten business days after the minutes have been approved.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able individu- ally identifiable information, such as your name, address, tele- phone telephone number, or social security numberSocial Security Number. Blue Shield of California will not disclose this information without your authorizationau- thorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S SHIELD OF CALIFORNIA’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s Shield of California's policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice "No- xxxx of Privacy Practices”", which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, listed in the back of this booklet or by accessing Blue Shield of California’s internet Cali- fornia's Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield of California may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose dis- close to Blue Shield of California that information that is reasonably rea- sonably needed by Blue ShieldShield of California. You agree to assist Blue Shield of California in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield of California with information in your possession. Failure to assist Blue Shield of California in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay xx- xxx or denial of benefits until the necessary in- formation information is receivedre- ceived. Any information received for this purpose by Blue Shield of California will be maintained as confidential and will not be disclosed without your consent, except as otherwise other- wise permitted by law. This procedure enables you to participate in establishing pub- lic policy of Blue Shield of California. It is not to be used as a substitute for the grievance procedure complaints, inquiries or requests for information. Public policy means acts performed by a plan or its employ- ees and staff to assure the comfort, dignity, and convenience of patients who rely on the plan's facilities to provide health care services to them, their families, and the public (Health and Safety Code, Section 1369). At least one third of the Board of Directors of Blue Shield of California is comprised of Subscribers who are not employ- ees, providers, subcontractors or group contract brokers and who do not have financial interests in Blue Shield of Califor- nia. The names of the members of the Board of Directors may be obtained from: Your recommendations, suggestions, or comments should be submitted in writing to the Sr. Manager, Regulatory Filings, at the above address, who will acknowledge receipt of your letter. Your name, address, phone number, Subscriber number, and group number should be included with each communication. The policy issue should be stated so that it will be readily un- derstood. Submit all relevant information and reasons for the policy issue with your letter. Policy issues will be heard at least quarterly as agenda items for meetings of the Board of Directors. Minutes of Board meetings will reflect decisions on public policy issues that were considered. If you have initiated a policy issue, appro- priate extracts of the minutes will be furnished to you within ten business days after the minutes have been approved.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. law.‌ A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx P. ACCESS TO INFORMATION Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able individu- ally identifiable information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S ’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentialityconfiden- tiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department Member Services at the telephone number indicated on your Identification Cardlisted in the back of this booklet, or by accessing Blue Shield of California’s internet Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx XxxxXxxxxxxx_Xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield of California may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield of California that information that is reasonably needed by Blue ShieldShield of California. You agree to assist Blue Shield of California in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate coop- erate by providing Blue Shield of California with information in your possession. Failure to assist Blue Shield of California in obtain- ing obtaining necessary information or refusal to provide in- formation infor- mation reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information in- formation received for this purpose by Blue Shield of Califor- nia will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.. This procedure enables you to participate in establishing public policy of Blue Shield of California. It is not to be used as a substitute for the grievance procedure, complaints, inquiries, or requests for information. Public policy means acts performed by a plan or its employees and staff to assure the comfort, dignity, and convenience of patients who rely on the plan’s facilities to provide health care services to them, their families, and the public (Health and Safety Code, Section 1369). At least one third of the Board of Directors of Blue Shield is comprised of Subscribers who are not employees, providers, subcontractors or group contract brokers and who do not have financial interests in Blue Shield. The names of the members of the Board of Directors may be obtained from: Please follow the following procedure:

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidenti- ality/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able identi- fiable information, such as your name, address, tele- phone telephone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Cardcard, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access ac- cess to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx xxxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility xxx- gibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including includ- ing signing any necessary authorizations) and to cooperate by providing Blue Shield with information infor- mation in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal re- fusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information in- formation received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able individu- ally identifiable information, such as your name, address, tele- phone telephone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTRE- QUEST. Blue Shield’s policies and procedures regarding our confidentialityconfi- dentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Cardlisted in the back of this booklet, or by accessing Blue Shield of CaliforniaCalifor- nia’s internet Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health informationinfor- mation, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx ACCESS TO INFORMATION Blue Shield of California may need information from medical medi- cal providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this AgreementContract. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed dis- closed without your consent, except as otherwise permitted by law.. CUSTOMER SERVICE FOR ALL SERVICES OTHER THAN MENTAL HEALTH If you have a question about services, providers, Benefits, how to use this Plan, or concerns regarding the quality of care or access to care that you have experienced, you may contact Blue Shield’s Customer Service Department as noted on the last page of this booklet. The hearing impaired may contact Blue Shield’s Customer Service Department through Blue Shield’s toll-free TTY number, 0-000-000-0000. Customer Service can answer many questions over the tele- phone. Note: Blue Shield of California has established a procedure for our Subscribers and Dependents to request an expedited decision. A Member, Physician, or representative of a Mem- ber may request an expedited decision when the routine deci- sion making process might seriously jeopardize the life or health of a Member, or when the Member is experiencing severe pain. Blue Shield shall make a decision and notify the Member and Physician as soon as possible to accommodate the Member’s condition not to exceed 72 hours following the receipt of the request. An expedited decision may involve admissions, continued stay, or other healthcare services. If you would like additional information regarding the expedit- ed decision process, or if you believe your particular situation qualifies for an expedited decision, please contact our Cus- tomer Service Department at the number noted on the last page of this booklet. FOR ALL MENTAL HEALTH SERVICES For all Mental Health Services Blue Shield of California has contracted with the Plan’s Mental Health Service Adminis- trator (MHSA). The MHSA should be contacted for ques- tions about Mental Health Services, MHSA network Provid- ers, or Mental Health Benefits. You may contact the MHSA at the telephone number or address which appear below: 0-000-000-0000 Blue Shield of California Mental Health Service Administrator

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your individually identifiable personal and health infor- mationinformation, including Protected Health Information. Personal and health Individually identifiable personal information includes both medical health, financial, and/or demographic information and individually identifi- able information, - such as your name, address, tele- phone number, or and social security number. Blue Shield will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD'S ’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain ” can be obtained either by calling the Customer Service Department at the telephone number indicated on your Identification Cardlisted in the back of this Evidence of Coverage, or by accessing Blue Shield of CaliforniaShield’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx xxx.xxxxxxxxxxxx.xxx and printing a copy. If you Members who are concerned that Blue Shield may have vi- olated your confidentiality/violated their privacy rights, or you who disagree with a decision we Blue Shield made about access to your their individually identifiable personal and health information, you may contact us Blue Shield at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxOffice P.O. Box 272540 Chico, XX 00000CA 95927-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx 2540 Blue Shield may need information from medical providers, from other carriers or other entities, or from youthe Member, in order to administer benefits the Benefits and eligi- bility eligibility provisions of this Agreement. You agree By enrolling in this health plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You Members also agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your the Member’s possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits Benefits until list dies about every three hours – all the necessary in- formation is receivedwhile waiting for an organ or tissue donation. Any For more information received on organ and tissue donation, or to register as a donor, visit the California Transplant Doctor Network’s internet site at xxx.xxxx.xxx or Donate Life California’s internet site at xxx.xxxxxxxxxxxxxxxxxxxx.xxx. Potential donors can also call the regional organ procurement agency in the nearest city nearest for this purpose by Blue Shield will be maintained as confidential additional information on organ and will not be disclosed without your consent, except as otherwise permitted by lawtissue donation.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able individu- ally identifiable information, such as your name, address, tele- phone telephone number, or social security numberSocial Security Number. Blue Shield of California will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S SHIELD OF CALIFORNIA’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s Shield of California's policies and procedures regarding our confidentiality/privacy practices are contained in the “"Notice of Privacy Practices”", which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, listed in the back of this booklet or by accessing Blue Shield of California’s internet 's Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield of California may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield of California that information that is reasonably needed by Blue ShieldShield of California. You agree to assist Blue Shield of California in obtaining this informationinfor- mation, if needed, (including signing any necessary authorizationsauthori- zations) and to cooperate by providing Blue Shield of Cali- fornia with information in your possession. Failure to assist Blue Shield of California in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result re- xxxx in the delay or denial of benefits until the necessary in- formation is received. Any information received for this purpose pur- pose by Blue Shield of California will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. Legal process or service upon Blue Shield of California must be served upon a corporate officer of Blue Shield of Califor- nia. Many residents in the state of California are eligible to be- come organ and tissue donors. By deciding to be an organ and tissue donor, you can affect the well-being of one or more of the estimated 100,000 people in the United States of America who must face death daily while waiting for an or- gan transplant. One person on this list dies about every three hours – all the while waiting for an organ or tissue donation. For more information on organ and tissue donation, or to register as a donor, visit the California Transplant Doctor Network’s internet site at xxxx://xxx.xxxx.xxx or Donate Life California’s internet site at xxxx://xxx.xxxxxxxxxxxxxxxxxxxx.xxx. You may also call the regional organ procurement agency in the city nearest you for additional information on organ and tissue donation. A Member may select any Hospital or Physician to provide covered Services hereunder, including providers outside of California. Benefits differ depending on whether a Preferred Provider or a Non-Preferred Provider is selected. It is to the Member's advantage to select Preferred Providers whenever possible. See the section entitled Definitions for additional information. A Directory of Preferred Physicians and Pre- ferred Hospitals has been provided to the Subscriber. A list- ing of Blue Shield of California Preferred Physicians and Preferred Hospitals may be viewed by accessing Blue Shield of California's Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx. An extra copy is available upon request by calling Blue Shield of California’s Customer Service Department at the telephone number indicated on your Identification Card or writing to: If the inability to perform by a Preferred Provider, the breach of the contract to furnish Services by a Preferred Provider, or the termination of a Preferred Provider's contract with Blue Shield of California may materially and adversely affect the Member, Blue Shield of California will, within a reasonable time, advise the Member in writing of such inability to per- form, breach, or termination. This Agreement, including the appendices, constitutes the entire agreement between parties. Any statement made by a Member shall, in the absence of fraud, be deemed a represen- tation and not a warranty. No change in this Agreement shall be valid unless approved by a corporate officer of Blue Shield of California and a written endorsement issued. No representative has authority to change this Agreement or to waive any of its provisions. Blue Shield of California will provide at least 60 days written notice of any changes to this Agreement. Attached to and incorporated in this Agreement by reference are appendices pertaining to Deductibles and dues. En- dorsements may be issued from time to time subject to the notice provisions in the section entitled Duration of the Agreement. Nothing contained in any endorsement shall affect this Agreement, except as expressly provided in the endorsement.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able identifiable information, such as your name, address, tele- phone number, telephone number or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTstatement describing Blue Shield’s policies and procedures for preserving the confidentiality of medical records is available and will be furnished to you upon request. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, Card or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able individu- ally identifiable information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S ’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentialityconfiden- tiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department Member Services at the telephone number indicated on your Identification Cardlisted in the back of this booklet, or by accessing Blue Shield of California’s internet Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 XxxxxP.O. Box 272540 Chico, XX CA 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx XxxxXxxxxxxx_Xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield of California may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits Benefits and eligi- bility eligibility provisions of this Agreement. You agree that any provider or entity can disclose to Blue Shield of California that information that is reasonably needed by Blue ShieldShield of California. You agree to assist Blue Shield of California in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate coop- erate by providing Blue Shield of California with information in your possession. Failure to assist Blue Shield of California in obtain- ing obtaining necessary information or refusal to provide in- formation infor- mation reasonably needed may result in the delay or denial of benefits Benefits until the necessary in- formation information is received. Any information infor- mation received for this purpose by Blue Shield of California will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law.. This procedure enables you to participate in establishing public policy of Blue Shield of California. It is not to be used as a substitute for the grievance procedure, complaints, inquiries, or requests for information. Public policy means acts performed by a plan or its employees and staff to assure the comfort, dignity, and convenience of pa- tients who rely on the plan’s facilities to provide Dental Care Services to them, their families, and the public (California Health and Safety Code, Section 1369). At least one third of the Board of Directors of Blue Shield is comprised of Subscribers who are not employees, providers, subcontractors or group contract brokers and who do not have financial interests in Blue Shield. The names of the members of the Board of Directors may be obtained from: Sr. Manager, Regulatory Filings Blue Shield of California 000 00xx Xxxxxx Phone Number: 0-000-000-0000 Please follow the following procedure:

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your individually identifiable personal and health infor- mationinformation, including Protected Health Information. Personal and health Individually identifiable personal information includes both medical health, financial, and/or demographic information and individually identifi- able information, - such as your name, address, tele- phone number, or and social security number. Blue Shield will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official X.X. Xxx 000000 Xxxxx, XX 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx Blue Shield may need information from medical providers, from other carriers or other entities, or from you, in order to administer benefits and eligi- bility provisions of this Agreement. You agree By enrolling in this health plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. You Members also agree to assist Blue Shield in obtaining this information, if needed, (including signing any necessary authorizations) and to cooperate by providing Blue Shield with information in your the Member’s possession. Failure to assist Blue Shield in obtain- ing obtaining necessary information or refusal to provide in- formation information reasonably needed may result in the delay or denial of benefits Benefits until the necessary in- formation information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without your consent, except as otherwise permitted by law. SHIELD’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s “Notice of Privacy Practices” can be obtained either by calling Customer Service at the number listed in the back of this Evidence of Coverage, or by accessing Blue Shield’s internet site at xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who are concerned that Blue Shield may have violated their privacy rights, or who disagree with a decision Blue Shield made about access to their individually identifiable personal information, may contact Blue Shield at: Blue Shield of California Privacy Office P.O. Box 272540 Chico, CA 95927-2540 Blue Shield may need information from medical providers, from other carriers or other entities, or from the Member, in order to administer the Benefits and eligibility provisions of this Legal process or service upon Blue Shield must be served upon Blue Shield’s Registered Agent for Service of Process or upon Blue Shield at Blue Shield’s corporate offices at 00 Xxxxx Xxxxxx, San Francisco, California 94105. Many residents in the state of California are eligible to become organ and tissue donors. Donors can affect the well-being of one or more of the estimated 100,000 people in the United States of America who must face death daily while waiting for an organ transplant. One person on this list dies about every three hours – all the while waiting for an organ or tissue donation. For more information on organ and tissue donation, or to register as a donor, visit the California Transplant Doctor Network’s internet site at xxx.xxxx.xxx or Donate Life California’s internet site at xxx.xxxxxxxxxxxxxxxxxxxx.xxx. Potential donors can also call the regional organ procurement agency in the nearest city nearest for additional information on organ and tissue donation.