Common use of Confidentiality of Personal and Health Information Clause in Contracts

Confidentiality of Personal and Health Information. Blue Shield protects the privacy of individually identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as name, address, and social security number. Blue Shield will not disclose this information without 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 “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: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 Chico, CA 95927-2540 Access to Information 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 Agreement. 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. 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 the Member’s possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably needed may result in the delay or denial of Benefits until the necessary information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without consent, except as otherwise permitted by law. Legal Process 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. Organ and Tissue Donation 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 confidentiality/privacy of individually your personal and health information. Personal and health information includes both medical information and individu- ally identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and social security telephone number, or Social Security Number. Blue Shield of California will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELDSHIELD 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” can be obtained ", which you may obtain either by calling the Customer Service Department at the number listed in the back of this Evidence of Coverage, booklet or by accessing Blue Shield’s internet Shield of California's Internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield of California may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office P.O. Official P. O. Box 272540 Chico, CA 9592700000-2540 0000 Toll-Free Telephone Number: 0-000-000-0000 E-mail Address: 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 the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this Agreement. By enrolling in this health plan, each Member agrees 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. Members also 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 the Member’s your possession. Failure to assist Blue Shield of California in obtaining necessary information or refusal to provide information reasonably needed may result re- xxxx in the delay or denial of Benefits benefits until the necessary information 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 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. Organ and Tissue Donation 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 confidenti- ality/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifiable personal identi- fiable information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and telephone number, or 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” can be obtained ”, which you may obtain either by calling the Customer Service Department at the telephone number listed in the back of this Evidence of Coverageindicated on your Identification Card, or by accessing Blue ShieldShield of California’s internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access ac- cess to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 ChicoOfficial X.X. Xxx 000000 Xxxxx, CA 95927XX 00000-2540 Access to Information 0000 Toll-Free Telephone: 0-000-000-0000 Email Address: xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx P. ACCESS TO INFORMATION Blue Shield may need information from medical providers, from other carriers or other entities, or from the Memberyou, in order to administer the Benefits benefits and eligibility xxx- gibility provisions of this Agreement. By enrolling in this health plan, each Member agrees You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. Members also 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 the Member’s your possession. Failure to assist Blue Shield in obtaining necessary information or refusal re- fusal to provide information reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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. Legal Process 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. Organ and Tissue Donation 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 protects the privacy of individually identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as name, address, and social security number. Blue Shield will not disclose this information without 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 “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: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 Chico, CA 95927-2540 Access to Information 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 Agreement. 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. 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 the Member’s possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably needed may result in the delay or denial of Benefits until the necessary information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without consent, except as otherwise permitted by law. Legal Process 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. Organ and Tissue Donation 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 protects the privacy of individually identifiable iden- tifiable personal information, including Protected Health Information. Individually identifiable personal per- xxxxx information includes health, financial, and/or demographic information - such as name, address, and social security number. Blue Shield will not disclose this information without authorization, except as permitted per- mitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD’S '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 “Notice of Privacy Practices” can be obtained either by calling Customer Service Shield Concierge at the number listed in the back of this Evidence of CoverageEOC, or by accessing access- ing 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: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 ChicoXxxxxx X.X. Xxx 000000 Xxxxx, CA 95927XX 00000-2540 0000 Access to Information 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 AgreementContract. By enrolling 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. 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 the Member’s their possession. Failure to assist Blue Shield in obtaining ob- taining necessary information or refusal to provide information reasonably needed may result in the delay xx- xxx or denial of Benefits until the necessary information 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 consent, except ex- cept as otherwise permitted by law. Legal Process 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. Organ and Tissue Donation 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 protects the privacy of individually identifiable personal information, including Protected Pro- tected Health Information. Individually identifiable identifi- able personal information includes health, financialxxxxx- cial, and/or demographic information - such as name, address, and social security number. Blue Shield will not disclose this information without 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 REQUESTRE- QUEST. 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 CoverageEOC, or by accessing ac- cessing 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 informationinforma- tion, may contact Blue Shield at: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 ChicoXxxxxx X.X. Xxx 000000 Xxxxx, CA 95927XX 00000-2540 0000 Access to Information Blue Shield may need information from medical providers, from other carriers or other entities, or from the Member, in order to administer the Benefits Ben- efits and eligibility provisions of this AgreementContract. By enrolling in this health planHealth Plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. 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 the Member’s possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably rea- sonably needed may result in the delay or denial of Benefits until the necessary information is receivedre- ceived. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without consent, except as otherwise permitted by law. Legal Process 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. Organ and Tissue Donation 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 protects the privacy of individually identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as name, address, and social security number. Blue Shield will not disclose this information without 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 “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: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 Chico, CA 95927-2540 Access to Information 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 Agreement. 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. 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 the Member’s possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably needed may result in the delay or denial of Benefits until the necessary information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without consent, except as otherwise permitted by law. Legal Process 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. Organ and Tissue Donation 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.as

Confidentiality of Personal and Health Information. Blue Shield of California protects the confidentiality/privacy of individually your personal and health information. Personal and health information includes both medical information and individu- ally identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and social security telephone number, or Social Security Number. Blue Shield of California will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELDSHIELD 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” can be obtained ", which you may obtain either by calling the Customer Service Department at the number listed in the back of this Evidence of Coverage, booklet or by accessing Blue Shield’s internet Shield of California's Internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield of California may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office P.O. Official P. O. Box 272540 Chico, CA 9592700000-2540 0000 Toll-Free Telephone Number: 0-000-000-0000 E-mail Address: 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 the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this Agreement. By enrolling in this health plan, each Member agrees 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. Members also 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 the Member’s your possession. Failure to assist Blue Shield of California in obtaining necessary information or refusal to provide information reasonably needed may result re- xxxx in the delay or denial of Benefits benefits until the necessary information 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 Legal process or service upon Blue Shield of California must be served upon Blue Shield’s Registered Agent for Service a corporate officer of Process or upon Blue Shield at Blue Shield’s corporate offices at 00 Xxxxx Xxxxxx, San Francisco, California 94105of Califor- nia. Organ and Tissue Donation Many residents in the state of California are eligible to become be- come organ and tissue donors. 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 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 xxx.xxxx.xxx xxxx://xxx.xxxx.xxx or Donate Life California’s internet site at xxx.xxxxxxxxxxxxxxxxxxxx.xxxxxxx://xxx.xxxxxxxxxxxxxxxxxxxx.xxx. Potential donors can You may also call the regional organ procurement agency in the nearest city nearest you for additional information on organ and tissue donation. Choice of Providers 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: Blue Shield of California PO Box 272540 Chico, CA 95927-2540 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. Entire Agreement: Changes 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. Endorsements and Appendices 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 privacy confidentiality / pri- vacy of your personal and health information. Personal and health information includes both medical information and individually identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and telephone number, or social security number. Blue Shield of California will not disclose this information without with- out your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELDSHIELD 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 regard- ing our confidentiality/privacy practices are contained in the “Notice of Privacy Practices” can be obtained ”, which you may obtain either by calling the Customer Service Department at the number listed in the back of this Evidence of Coveragebooklet, or by accessing Blue ShieldShield of California’s internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield of California may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable personal your per- xxxxx and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office Official P.O. Box 272540 Chico, CA 9592700000-2540 0000 Toll-Free Telephone: 0-000-000-0000 E-mail Address: 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 the Memberyou, in order to administer the Benefits benefits and eligibility provisions provi- sions of this Agreement. By enrolling in this health plan, each Member agrees 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. Members also 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 the Member’s possessionyour posses- sion. Failure to assist Blue Shield of California in obtaining necessary information or refusal to provide information reasonably rea- sonably needed may result in the delay or denial of Benefits benefits until the necessary 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 Legal process or service upon Blue Shield of California must be served upon Blue Shield’s Registered Agent for Service a corporate officer of Process or upon Blue Shield at Blue Shield’s corporate offices at 00 Xxxxx Xxxxxx, San Francisco, California 94105of California. Organ and Tissue Donation Many residents in the state of California are eligible to become be- come organ and tissue donors. 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 donationdo- 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 xxx.xxxx.xxx xxxx://xxx.xxxx.xxx or Donate Life California’s internet site at xxx.xxxxxxxxxxxxxxxxxxxx.xxxxxxx://xxx.xxxxxxxxxxxxxxxxxxxx.xxx. Potential donors can You may also call the regional organ procurement agency in the nearest city nearest you for additional information on organ and tissue donation. Choice of Providers 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. Entire Agreement: Changes 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. Endorsements and Appendices 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 confidentiality/privacy of individually your personal and health information. Personal and health information includes both medical information and individu- ally identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and telephone number, or 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 REQUESTRE- QUEST. Blue Shield’s policies and procedures regarding our confidenti- ality/privacy practices are contained in the “Notice of Privacy Practices” can be obtained ”, which you may obtain either by calling Customer Service the Member Services Department at the number listed in provided on the back last page of this Evidence of Coveragebooklet, or by accessing Blue ShieldShield of California’s internet Inter- net site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal informationand health infor- mation, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 ChicoOfficial X.X. Xxx 000000 Xxxxx, CA 95927XX 00000-2540 Access to Information 0000 Toll-Free Telephone: 0-000-000-0000 Email Address: 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 the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this AgreementContract. By enrolling in this health plan, each Member agrees You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. Members also 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 the Member’s your possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information in- formation reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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 Legal process or service upon Blue Shield must be served upon Blue Shield’s Registered Agent for Service NON-ASSIGNABILITY Benefits of Process or upon Blue Shield at Blue Shield’s corporate offices at 00 Xxxxx Xxxxxx, San Francisco, California 94105this Plan are not assignable. Organ and Tissue Donation 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 donationPLEASE 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 confidenti- ality/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifiable personal identi- fiable information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and telephone number, or 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” can be obtained ”, which you may obtain either by calling the Customer Service Department at the telephone number listed in the back of this Evidence of Coverageindicated on your Identification Card, or by accessing Blue ShieldShield of California’s internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access ac- cess to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office Official P.O. Box 272540 Chico, CA 9592700000-2540 Access to Information 0000 Toll-Free Telephone: 0-000-000-0000 Email Address: xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx P. ACCESS TO INFORMATION Blue Shield may need information from medical providers, from other carriers or other entities, or from the Memberyou, in order to administer the Benefits benefits and eligibility xxx- gibility provisions of this Agreement. By enrolling in this health plan, each Member agrees You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. Members also 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 the Member’s your possession. Failure to assist Blue Shield in obtaining necessary information or refusal re- fusal to provide information reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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. Legal Process 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. Organ and Tissue Donation 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 confidentiality/privacy of individually your personal and health information. Personal and health information includes both medical information and individu- ally identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and tele- phone number, or 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 confiden- tiality/privacy practices are contained in the “Notice of Privacy Practices” can be obtained ”, which you may obtain either by calling Customer Service the Member Services at the number listed in the back of this Evidence of Coveragebooklet, or by accessing Blue ShieldShield of California’s internet Internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office Official P.O. Box 272540 Chico, CA 9592700000-2540 0000 Free Telephone: 0-000-000-0000 Email Address: 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 the Memberyou, in order to administer the Benefits and eligibility provisions of this Agreement. By enrolling in this health plan, each Member agrees 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. Members also 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 the Member’s your possession. Failure to assist Blue Shield of California in obtaining necessary information or refusal to provide information infor- mation reasonably needed may result in the delay or denial of Benefits until the necessary 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. Legal Process Legal process or service upon Public Policy Participation Procedure This procedure enables you to participate in establishing public policy of Blue Shield must of California. It is not to be served upon 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’s Registered Agent for Service . The names of Process or upon the members of the Board of Directors may be obtained from: Sr. Manager, Regulatory Filings Blue Shield at Blue Shield’s corporate offices at 00 Xxxxx Xxxxxx, San Francisco, California 94105. Organ and Tissue Donation Many residents in the state of California are eligible to become organ and tissue donors. Donors can affect 000 00xx Xxxxxx Oakland, CA 94607 Phone Number: 0-000-000-0000 Please follow 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.following procedure:

Confidentiality of Personal and Health Information. Blue Shield protects the privacy of individually identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as name, address, and social security number. Blue Shield will not disclose this information without authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE Agreement. 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. 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 the Member’s possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably needed may result in the delay or denial of Benefits until the necessary information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without 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: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 Chico, CA 95927-2540 Access to Information 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 Agreement. 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. 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 the Member’s possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably needed may result in the delay or denial of Benefits until the necessary information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without consent, except as otherwise permitted by law. Legal Process 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. Organ and Tissue Donation 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 confidentiality/privacy of individually your personal and health information. Personal and health information includes both medical information and individu- ally identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and tel- ephone number, or social security number. Blue Shield will not disclose this information without your authorization, except ex- cept 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 confiden- tiality/privacy practices are contained in the “Notice of Privacy Xxxxx- cy Practices” can be obtained ”, which you may obtain either by calling Customer Service the Member Services at the number listed in the back of this Evidence of Coveragebooklet, or by accessing Blue ShieldShield of California’s internet Internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal informationand health infor- mation, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office Official P.O. Box 272540 Chico, CA 9592700000-2540 0000 Free Telephone: 0-000-000-0000 Email Address: 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 the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this Agreement. By enrolling in this health plan, each Member agrees 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. Members also 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 the Member’s your possession. Failure to assist Blue Shield of California in obtaining necessary information or refusal to provide information reasonably needed may result in the delay xx- xxx or denial of Benefits benefits until the necessary 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. Legal Process Legal process or service upon Public Policy Participating Procedure This procedure enables you to participate in establishing pub- lic policy of Blue Shield must of California. It is not to be served upon 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’s Registered Agent for Service . The names of Process or upon the members of the Board of Directors may be obtained from: Sr. Manager, Regulatory Filings Blue Shield at Blue Shield’s corporate offices at of California 00 Xxxxx Xxxxxx, Xxxxxx San Francisco, California 94105. Organ and Tissue Donation Many residents in CA 94105 Phone Number: 000-000-0000 Please follow 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.following procedure:

Confidentiality of Personal and Health Information. Blue Shield protects the privacy of individually identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as name, address, and social security number. Blue Shield will not disclose this information without 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 “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: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 Chico, CA 95927-2540 Access to Information 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 Agreement. 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. 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 the Member’s possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably needed may result in the delay or denial of Benefits until the necessary information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without consent, except as otherwise permitted by law. Legal Process 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. Organ and Tissue Donation 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 confidentiality/privacy of individually identifiable your personal and health information, including Protected Health Informationyour medical records, claims and personal information. Individually identifiable personal Personal and health information includes healthboth medical information and individually identifiable information, financial, and/or demographic information - such as your name, address, and telephone number, or 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 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” can be obtained ”, which you may obtain either by calling the Customer Service Department at the telephone number listed in the back of this Evidence of Coverageindicated on your Identification Card, or by accessing Blue ShieldShield of California’s internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office Official P.O. Box 272540 Chico, CA 9592700000-2540 Access to Information 0000 Toll-Free Telephone: 0-000-000-0000 Email Address: xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx P. ACCESS TO INFORMATION Blue Shield may need information from medical providers, from other carriers or other entities, or from the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this Agreement. By enrolling in this health plan, each Member agrees You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. Members also 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 the Member’s your possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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 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. Organ and Tissue Donation 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 confidentiality/privacy of individually your personal and health information. Personal and health information includes both medical information and individual- ly identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except ex- cept as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD’S '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 confidenti- ality/privacy practices are contained in the “Notice of Privacy Practices” can be obtained ”, which you may obtain either by calling Customer Service the Member Services Department at the number listed in provided on the back last page of this Evidence of Coveragebooklet, or by accessing Blue ShieldShield of California’s internet Internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal informationand health infor- mation, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 ChicoOfficial X.X. Xxx 000000 Xxxxx, CA 95927XX 00000-2540 Access to Information 0000 Toll-Free Telephone: 0-000-000-0000 Email Address: 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 the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this AgreementContract. By enrolling in this health plan, each Member agrees You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. Members also 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 the Member’s your possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information in- formation reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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 Legal process or service upon Blue Shield must be served upon Blue Shield’s Registered Agent for Service NON-ASSIGNABILITY Benefits of Process or upon Blue Shield at Blue Shield’s corporate offices at 00 Xxxxx Xxxxxx, San Francisco, California 94105this Plan are not assignable. Organ and Tissue Donation 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 donationPLEASE 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 protects the privacy of individually identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as name, address, and social security number. Blue Shield will not disclose this information without 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 “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: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 Chico, CA 95927-2540 Access to Information 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 Agreement. 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. 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 the Member’s possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably needed may result in the delay or denial of Benefits until the necessary information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without consent, except as otherwise permitted by law. Legal Process 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. Organ and Tissue Donation 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 confidenti- ality/privacy of your personal and health infor- mation, including your medical records, claims and personal information. Personal and health in- formation includes both medical information and individually identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and telephone number, or social security secu- rity number. Blue Shield will not disclose this information in- formation 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 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” can be obtained ”, which you may obtain either by calling the Customer Service Department at the telephone number listed in the back of this Evidence of Coverageindicated on your Identification Card, or by accessing Blue ShieldShield of California’s internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access ac- cess to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office Official P.O. Box 272540 Chico, CA 9592700000-2540 Access to Information 0000 Toll-Free Telephone: 0-000-000-0000 Email Address: xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx P. ACCESS TO INFORMATION Blue Shield may need information from medical providers, from other carriers or other entities, or from the Memberyou, in order to administer the Benefits benefits and eligibility xxx- gibility provisions of this Agreement. By enrolling in this health plan, each Member agrees You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. Members also 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 the Member’s your possession. Failure to assist Blue Shield in obtaining necessary information or refusal re- fusal to provide information reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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. Legal Process 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. Organ and Tissue Donation 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 confidentiality/privacy of individually your personal and health information. Personal and health information includes both medical information and individu- ally identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and telephone number, or 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 REQUESTRE- QUEST. Blue Shield’s policies and procedures regarding our confi- dentiality/privacy practices are contained in the “Notice of Privacy Practices” can be obtained ”, which you may obtain either by calling the Customer Service Department at the number listed in the back of this Evidence of Coveragebooklet, or by accessing Blue ShieldShield of Califor- nia’s internet Internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal informationand health infor- mation, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office Official P.O. Box 272540 Chico, CA 9592700000-2540 Access to Information 0000 Toll-Free Telephone: 0-000-000-0000 Email Address: 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 the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this AgreementContract. By enrolling in this health plan, each Member agrees You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. Members also 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 the Member’s your possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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. Legal Process Legal process CUSTOMER SERVICE FOR ALL SERVICES OTHER THAN MENTAL HEALTH If you have a question about services, providers, Benefits, how to use this Plan, or service upon Blue Shield must be served upon concerns regarding the quality of care or access to care that you have experienced, you may contact Blue Shield’s Registered Agent for Customer Service Department as noted on the last page of Process or upon Blue Shield at this booklet. The hearing impaired may contact Blue Shield’s corporate offices at 00 Xxxxx XxxxxxCustomer Service Department through Blue Shield’s toll-free TTY number, San Francisco, California 941050-000-000-0000. Organ and Tissue Donation Many residents in Customer Service can answer many questions over the state tele- phone. Note: Blue Shield of California are eligible has established a procedure for our Subscribers and Dependents to become organ 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 tissue donors. Donors can affect notify the well-being of one or more Member and Physician as soon as possible to accommodate the Member’s condition not to exceed 72 hours following the receipt of the estimated 100,000 people in request. An expedited decision may involve admissions, continued stay, or other healthcare services. If you would like additional information regarding the United States of America who must face death daily while waiting expedit- ed decision process, or if you believe your particular situation qualifies for an organ transplantexpedited decision, please contact our Cus- tomer Service Department at the number noted on the last page of this booklet. One person on this list dies 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 every three hours – all the while waiting for an organ or tissue donation. For more information on organ and tissue donationMental Health Services, MHSA network Provid- ers, or to register as a donor, visit 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 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.Mental Health Service Administrator

Confidentiality of Personal and Health Information. Blue Shield protects the privacy of individually identifiable iden- tifiable personal information, including Protected Health Information. Individually identifiable personal per- xxxxx information includes health, financial, and/or demographic information - such as name, address, and social security number. Blue Shield will not disclose this information without authorization, except as permitted per- mitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD’S '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 “Notice of Privacy Practices” can be obtained either by calling Customer Service at the number listed in the back of this Evidence of CoverageEOC, or by accessing access- ing 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: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 ChicoXxxxxx X.X. Xxx 000000 Xxxxx, CA 95927XX 00000-2540 0000 Access to Information 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 AgreementContract. By enrolling 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. 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 the Member’s their possession. Failure to assist Blue Shield in obtaining ob- taining necessary information or refusal to provide information reasonably needed may result in the delay xx- xxx or denial of Benefits until the necessary information 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 consent, except ex- cept as otherwise permitted by law. Legal Process 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. Organ and Tissue Donation 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 protects the privacy of individually identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as name, address, and social security number. Blue Shield will not disclose this information without 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 “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: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 Chico, CA 95927-2540 Access to Information 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 Agreement. 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. 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 the Member’s possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably needed may result in the delay or denial of Benefits until the necessary information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without consent, except as otherwise permitted by law. Legal Process 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. Organ and Tissue Donation 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. Entire Agreement: Changes 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 confidentiality/privacy of individually your personal and health information. Personal and health information includes both medical information and individu- ally identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and social security telephone number, or Social Security Number. Blue Shield of California will not disclose this information without authorizationyour au- thorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELDSHIELD 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 “Notice Shield of California's policies and procedures regarding our confidentiality/privacy practices are contained in the "No- xxxx of Privacy Practices” can be obtained ", which you may obtain either by calling the Customer Service Department at the number listed in the back of this Evidence of Coverage, booklet or by accessing Blue Shield’s internet Shield of Cali- fornia's Internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield of California may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office P.O. Official P. O. Box 272540 Chico, CA 9592700000-2540 0000 Toll-Free Telephone Number: 0-000-000-0000 E-mail Address: 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 the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this Agreement. By enrolling in this health plan, each Member agrees 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. Members also 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 the Member’s your possession. Failure to assist Blue Shield of California in obtaining necessary information or refusal to provide information reasonably needed may result in the delay xx- xxx or denial of Benefits benefits until the necessary 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. Legal Process Legal process or service upon Public Participation Procedure This procedure enables you to participate in establishing pub- lic policy of Blue Shield must of California. It is not to be served upon Blue Shield’s Registered Agent used as a substitute for Service 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 Process or upon 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 at 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’s corporate offices at Shield of Califor- nia. The names of the members of the Board of Directors may be obtained from: Sr. Manager, Regulatory Filings Blue Shield of California 00 Xxxxx Xxxxxx, Xxxxxx San Francisco, California 94105CA 94105 Phone: 0-000 000-0000 Procedure Your recommendations, suggestions, or comments should be submitted in writing to the Sr. Organ Manager, Regulatory Filings, at the above address, who will acknowledge receipt of your letter. Your name, address, phone number, Subscriber number, and Tissue Donation Many residents in 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 state of California are eligible to become organ and tissue donorspolicy issue with your letter. Donors can affect the well-being of one or more Policy issues will be heard at least quarterly as agenda items for meetings of the estimated 100,000 people in 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 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 minutes will be furnished to you within ten business days after 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 donationminutes have been approved.

Confidentiality of Personal and Health Information. Blue Shield protects the privacy of individually identifiable personal information, including Protected Pro- tected Health Information. Individually identifiable identifi- able personal information includes health, financialxxxxx- cial, and/or demographic information - such as name, address, and social security number. Blue Shield will not disclose this information without 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 REQUESTRE- QUEST. 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 CoverageEOC, or by accessing ac- cessing 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 informationinforma- tion, may contact Blue Shield at: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 Chico, CA 95927-2540 Access to Information Blue Shield may need information from medical providers, from other carriers or other entities, or from the Member, in order to administer the Benefits Ben- efits and eligibility provisions of this AgreementContract. By enrolling in this health planHealth Plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. 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 the Member’s possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably rea- sonably needed may result in the delay or denial of Benefits until the necessary information is receivedre- ceived. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without consent, except as otherwise permitted by law. Legal Grievance Process Legal process or service upon Blue Shield must be served upon has established a grievance procedure for receiving, resolving and tracking Members’ grievances with 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. Organ and Tissue Donation 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- ity/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifiable personal identifi- able information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and tele- phone number, or 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” can be obtained ”, which you may obtain either by calling the Customer Service Department at the telephone number listed in the back of this Evidence of Coverageindicated on your Identification Card, or by accessing Blue ShieldShield of California’s internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their vi- olated your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 ChicoOfficial X.X. Xxx 000000 Xxxxx, CA 95927XX 00000-2540 Access to Information 0000 Toll-Free Telephone: 0-000-000-0000 Email Address: xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx P. ACCESS TO INFORMATION Blue Shield may need information from medical providers, from other carriers or other entities, or from the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this Agreement. By enrolling in this health plan, each Member agrees You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. Members also 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 the Member’s your possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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 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. Organ and Tissue Donation 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 confidentiality/privacy of individually your personal and health information. Personal and health information includes both medical information and individu- ally identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and social security tele- phone number, or Social Security Number. Blue Shield of California will not disclose this information without authorizationyour au- thorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELDSHIELD 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 “Notice Shield of California's policies and procedures regarding our confidentiality/privacy practices are contained in the "No- xxxx of Privacy Practices” can be obtained ", which you may obtain either by calling call- ing the Customer Service Department at the number listed in the back of this Evidence of Coverage, booklet or by accessing Blue Shield’s internet Shield of Califor- nia's Internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield of California may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office P.O. Official P. O. Box 272540 Chico, CA 9592700000-2540 0000 Toll-Free Telephone Number: 0-000-000-0000 E-mail Address: 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 the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this Agreement. By enrolling in this health plan, each Member agrees 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. Members also 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 the Member’s your possession. Failure to assist Blue Shield of California in obtaining necessary information or refusal to provide information infor- mation reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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. Legal Process Legal process or service upon Public Participation Procedure This procedure enables you to participate in establishing public policy of Blue Shield must of California. It is not to be served upon Blue Shield’s Registered Agent used as a substitute for Service 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 Process or upon 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 at 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’s corporate offices at Shield of California. The names of the members of the Board of Directors may be obtained from: Sr. Manager, Regulatory Filings Blue Shield of California 00 Xxxxx Xxxxxx, Xxxxxx San Francisco, California 94105CA 94105 Phone: 0-000 000-0000 Procedure Your recommendations, suggestions, or comments should be submitted in writing to the Sr. Organ Manager, Regulatory Filings, at the above address, who will acknowledge receipt of your letter. Your name, address, phone number, Subscriber number, and Tissue Donation Many residents in 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 state of California are eligible to become organ and tissue donorspolicy issue with your letter. Donors can affect the well-being of one or more Policy issues will be heard at least quarterly as agenda items for meetings of the estimated 100,000 people in 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 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 minutes will be furnished to you within ten business days after 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 donationminutes have been approved.

Confidentiality of Personal and Health Information. Blue Shield of California protects the confidentiality/privacy of individually your personal and health information. Personal and health information includes both medical information and individu- ally identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and social security telephone number, or Social Security Number. Blue Shield of California will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELDSHIELD 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” can be obtained ", which you may obtain either by calling the Customer Service Department at the number listed in the back of this Evidence of Coverage, booklet or by accessing Blue Shield’s internet Shield of California's Internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield of California may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office P.O. Official P. O. Box 272540 Chico, CA 9592700000-2540 0000 Toll-Free Telephone Number: 0-000-000-0000 E-mail Address: 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 the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this Agreement. By enrolling in this health plan, each Member agrees 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. Members also 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 the Member’s your possession. Failure to assist Blue Shield of California in obtaining necessary information or refusal to provide information reasonably needed may result re- xxxx in the delay or denial of Benefits benefits until the necessary information 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 Legal process or service upon Blue Shield of California must be served upon Blue Shield’s Registered Agent for Service a corporate officer of Process or upon Blue Shield at Blue Shield’s corporate offices at 00 Xxxxx Xxxxxx, San Francisco, California 94105of Califor- nia. Organ and Tissue Donation Many residents in the state of California are eligible to become be- come organ and tissue donors. 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 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 xxx.xxxx.xxx xxxx://xxx.xxxx.xxx or Donate Life California’s internet site at xxx.xxxxxxxxxxxxxxxxxxxx.xxxxxxx://xxx.xxxxxxxxxxxxxxxxxxxx.xxx. Potential donors can You may also call the regional organ procurement agency in the nearest city nearest you for additional information on organ and tissue donation. Choice of Providers 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: Blue Shield of California PO Box 272540 Chico, CA 95927-2540 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. Entire Agreement: Changes 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. Endorsements and Appendices 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 protects the privacy of individually identifiable personal information, including Protected Pro- tected Health Information. Individually identifiable identifi- able personal information includes health, financialxxxxx- cial, and/or demographic information - such as name, address, and social security number. Blue Shield will not disclose this information without 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 REQUESTRE- QUEST. 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 CoverageEOC, or by accessing ac- cessing 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 informationinforma- tion, may contact Blue Shield at: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 Chico, CA 95927-2540 Access to Information Blue Shield may need information from medical providers, from other carriers or other entities, or from the Member, in order to administer the Benefits Ben- efits and eligibility provisions of this AgreementContract. By enrolling in this health planHealth Plan, each Member agrees that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. 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 the Member’s possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably rea- sonably needed may result in the delay or denial of Benefits until the necessary information is receivedre- ceived. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without consent, except as otherwise permitted by law. Legal Grievance Process Legal process or service upon Blue Shield must be served upon Blue Shieldhas established a grievance procedure days following any incident or action that is the subject of the Member’s Registered Agent for Service dissatisfaction. Members can request an expedited decision when the routine decision making process might seriously jeopardize the life or health of Process a Member, or upon when the Member is experiencing severe pain. Blue Shield at Blue Shieldshall make a decision and notify the Member and Physician as soon as possible to accommodate the Member’s corporate offices at 00 Xxxxx Xxxxxx, San Francisco, California 94105. Organ and Tissue Donation Many residents in condition not to exceed 72 hours following the state of California are eligible to become organ and tissue donors. Donors can affect the well-being of one or more receipt of the estimated 100,000 people in the United States of America who must face death daily while waiting for an organ transplantrequest. One person on this list dies about every three hours – all the while waiting for an organ An expedited decision may involve admissions, continued stay, or tissue donationother healthcare services. For more additional information on organ and tissue donationregarding the expedited decision process, or to register as request an expedited decision be made for a donorparticular issue, visit the California Transplant Doctor Network’s internet site at xxx.xxxx.xxx or Donate Life California’s internet site at xxx.xxxxxxxxxxxxxxxxxxxx.xxxplease contact Customer Service. Potential donors can also call the regional organ procurement agency in the nearest city nearest for additional information on organ receiving, resolving and tissue donationtracking Members’ grievances with Blue Shield.

Confidentiality of Personal and Health Information. Blue Shield protects the privacy of individually identifiable personal information, including Protected Pro- tected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as name, addressad- dress, and social security number. Blue Shield will not disclose this information without authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELD’S 'S POLICIES AND PROCEDURES FOR PRESERVING PRE- SERVING THE CONFIDENTIALITY OF MEDICAL MEDI- CAL 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 CoverageEOC, 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: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 Chico, CA 95927-2540 access- Access to Information Blue Shield may need information from medical providers, from other carriers or other entities, or from the Member, in order to administer the Benefits Bene- fits and eligibility provisions of this AgreementContract. 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. 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 the Member’s their possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably needed may result re- xxxx in the delay or denial of Benefits until the necessary nec- xxxxxx information is received. Any information received for this purpose by Blue Shield will be maintained as confidential and will not be disclosed without consent, except as otherwise permitted by law. Legal Grievance Process Legal process or service upon Blue Shield must be served upon has established a grievance procedure for receiving, resolving and tracking Members’ grievances with 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. Organ and Tissue Donation 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 confidenti- ality/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifiable personal identi- fiable information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and telephone number, or 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 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” can be obtained ”, which you may obtain either by calling the Customer Service Department at the telephone number listed in the back of this Evidence of Coverageindicated on your Identification Card, or by accessing Blue ShieldShield of California’s internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access ac- cess to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office Official P.O. Box 272540 Chico, CA 9592700000-2540 Access to Information 0000 Toll-Free Telephone: 0-000-000-0000 Email Address: xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx P. ACCESS TO INFORMATION Blue Shield may need information from medical providers, from other carriers or other entities, or from the Memberyou, in order to administer the Benefits benefits and eligibility xxx- gibility provisions of this Agreement. By enrolling in this health plan, each Member agrees You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. Members also 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 the Member’s your possession. Failure to assist Blue Shield in obtaining necessary information or refusal re- fusal to provide information reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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. Legal Process 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. Organ and Tissue Donation 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 confidentiality/privacy of your personal and health information. Personal and health information includes both medical information and individually identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and telephone number or 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 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” can be obtained ”, which you may obtain either by calling the Customer Service Department at the telephone number listed in the back of this Evidence of Coverageindicated on your Identification Card, or by accessing Blue ShieldShield of California’s internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office Official P.O. Box 272540 Chico, CA 9592700000-2540 Access to Information 0000 Toll-Free Telephone: 0-000-000-0000 Email Address: xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx P. ACCESS TO INFORMATION Blue Shield may need information from medical providers, from other carriers or other entities, or from the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this Agreement. By enrolling in this health plan, each Member agrees You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. Members also 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 the Member’s your possession. Failure to assist Blue Shield in obtaining necessary information or refusal to provide information reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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 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. Organ and Tissue Donation 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 confidentiality/privacy of individually your personal and health information. Personal and health information includes both medical information and individu- ally identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and tele- phone number, or 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 confiden- tiality/privacy practices are contained in the “Notice of Privacy Practices” can be obtained ”, which you may obtain either by calling Customer Service the Member Services at the number listed in the back of this Evidence of Coveragebooklet, or by accessing Blue ShieldShield of California’s internet Internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office Official P.O. Box 272540 Chico, CA 9592700000-2540 0000 Free Telephone: 0-000-000-0000 Email Address: 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 the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this Agreement. By enrolling in this health plan, each Member agrees 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. Members also 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 the Member’s your possession. Failure to assist Blue Shield of California in obtaining necessary information or refusal to provide information infor- mation reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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. Legal Process Legal process or service upon Public Policy Participating Procedure This procedure enables you to participate in establishing public policy of Blue Shield must of California. It is not to be served upon 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’s Registered Agent for Service . The names of Process or upon the members of the Board of Directors may be obtained from: Sr. Manager, Regulatory Filings Blue Shield at Blue Shield’s corporate offices at of California 00 Xxxxx Xxxxxx, Xxxxxx San Francisco, California 94105. Organ and Tissue Donation Many residents in CA 94105 Phone Number: 000-000-0000 Please follow 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.following procedure:

Confidentiality of Personal and Health Information. Blue Shield of California protects the confidentiality/privacy of individually your personal and health information. Personal and health information includes both medical information and individu- ally identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and social security telephone number, or Social Security Number. Blue Shield of California will not disclose this information without your authorization, except as permitted or required by law. A STATEMENT DESCRIBING BLUE SHIELDSHIELD 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” can be obtained ", which you may obtain either by calling the Customer Service Department at the number listed in the back of this Evidence of Coverage, booklet or by accessing Blue Shield’s internet Shield of California's Internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield of California may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office P.O. Official P. O. Box 272540 Chico, CA 9592700000-2540 0000 Toll-Free Telephone Number: 0-000-000-0000 E-mail Address: 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 the Memberyou, in order to administer the Benefits benefits and eligibility provisions of this Agreement. By enrolling in this health plan, each Member agrees 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. Members also 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 the Member’s your possession. Failure to assist Blue Shield of California in obtaining necessary information or refusal to provide information reasonably needed may result re- xxxx in the delay or denial of Benefits benefits until the necessary information 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 Legal process or service upon Blue Shield of California must be served upon Blue Shield’s Registered Agent for Service a corporate officer of Process or upon Blue Shield at Blue Shield’s corporate offices at 00 Xxxxx Xxxxxx, San Francisco, California 94105of Califor- nia. Organ and Tissue Donation Many residents in the state of California are eligible to become be- come organ and tissue donors. 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 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 xxx.xxxx.xxx xxxx://xxx.xxxx.xxx or Donate Life California’s internet site at xxx.xxxxxxxxxxxxxxxxxxxx.xxxxxxx://xxx.xxxxxxxxxxxxxxxxxxxx.xxx. Potential donors can You may also call the regional organ procurement agency in the nearest city nearest you for additional information on organ and tissue donation. Choice of Providers 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: Blue Shield of California PO Box 272540 Chico, CA 95927-2540 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. Entire Agreement: Changes 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. Endorsements and Appendices 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 confidenti- ality/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifiable personal identi- fiable information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and telephone number, or 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” can be obtained ”, which you may obtain either by calling the Customer Service Department at the telephone number listed in the back of this Evidence of Coverageindicated on your Identification Card, or by accessing Blue ShieldShield of California’s internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access ac- cess to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office Official P.O. Box 272540 Chico, CA 9592700000-2540 Access to Information 0000 Toll-Free Telephone: 0-000-000-0000 Email Address: xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx P. ACCESS TO INFORMATION Blue Shield may need information from medical providers, from other carriers or other entities, or from the Memberyou, in order to administer the Benefits benefits and eligibility xxx- gibility provisions of this Agreement. By enrolling in this health plan, each Member agrees You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. Members also 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 the Member’s your possession. Failure to assist Blue Shield in obtaining necessary information or refusal re- fusal to provide information reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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. Legal Process 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. Organ and Tissue Donation 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 confidenti- ality/privacy of your personal and health infor- mation, including your medical records, claims and personal information. Personal and health in- formation includes both medical information and individually identifiable personal information, including Protected Health Information. Individually identifiable personal information includes health, financial, and/or demographic information - such as your name, address, and telephone number, or social security secu- rity number. Blue Shield will not disclose this information in- formation 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 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” can be obtained ”, which you may obtain either by calling call- ing the Customer Service Department at the tele- phone number listed in the back of this Evidence of Coverageindicated on your Identification Card, or by accessing Blue ShieldShield of California’s internet site located at xxx.xxxxxxxxxxxx.xxx xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. Members who If you are concerned that Blue Shield may have violated their your confidentiality/privacy rights, or who you disagree with a decision Blue Shield we made about access ac- cess to their individually identifiable your personal and health information, you may contact Blue Shield us at: Correspondence Address: Blue Shield of California Privacy Office P.O. Box 272540 ChicoOfficial X.X. Xxx 000000 Xxxxx, CA 95927XX 00000-2540 Access to Information 0000 Toll-Free Telephone: 0-000-000-0000 Email Address: xxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx P. ACCESS TO INFORMATION Blue Shield may need information from medical providers, from other carriers or other entities, or from the Memberyou, in order to administer the Benefits benefits and eligibility xxx- gibility provisions of this Agreement. By enrolling in this health plan, each Member agrees You agree that any provider or entity can disclose to Blue Shield that information that is reasonably needed by Blue Shield. Members also 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 the Member’s your possession. Failure to assist Blue Shield in obtaining necessary information or refusal re- fusal to provide information reasonably needed may result in the delay or denial of Benefits benefits until the necessary 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. Legal Process 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. Organ and Tissue Donation 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.