Common use of Department of Managed Health Care Review Clause in Contracts

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice plans. If you have a grievance against your health Plan, you should first telephone your health Plan at the telephone number indicated on your Identification Card and use your health Plan’s grievance process before contacting the Depart- ment. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health Plan, or a grievance that has remained unre- solved for more than 30 days, you may call the De- partment for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical Services. The De- partment also has a toll-free telephone number (0- 000-000-0000) and a TDD line (0-000-000-0000) for the hearing and speech impaired. The Depart- ment’s Internet Web site (xxx.xxxx.xx.xxx) has complaint forms, IMR application forms and in- structions online. In the event that Blue Shield should cancel or re- fuse to renew your enrollment and you feel that such action was due to reasons of health or utiliza- tion of benefits, you may request a review by the Department of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice plans. If you have a grievance against your health Plan, you should first telephone your health Plan at the telephone number indicated on your Identification Card and use your health Plan’s grievance process before contacting the Depart- ment. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health Plan, or a grievance that has remained unre- solved for more than 30 days, you may call the De- partment for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical Services. The De- partment also has a toll-free telephone number (0- 0-000-000-0000) and a TDD line (01-000877-000-0000688- 9891) for the hearing and speech impaired. The Depart- mentDepartment’s Internet Web site internet website (xxx.xxxx.xx.xxxxxxx://xxx.xxxx.xx.xxx) has complaint forms, IMR application forms and in- structions instructions online. In the event that Blue Shield should cancel or re- fuse to renew your enrollment and you feel that such action was due to reasons of health or utiliza- tion of benefits, you may request a review by the Department of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice plans. If you have a grievance against your health Plan, you should first telephone your health Plan at the telephone number indicated on your Identification Card and use your health Plan’s grievance process before contacting the Depart- ment. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health Plan, or a grievance that has remained unre- solved un- resolved for more than 30 days, you may call the De- partment Department for assistance. You may also be eligible xxxxx- ble for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity ne- cessity of a proposed service or treatment, coverage cover- age decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical Services. The De- partment Department also has a toll-free telephone number (0- 0-000-000-0000) and a TDD line (01-000877-000-0000688- 9891) for the hearing and speech impaired. The Depart- mentDepartment’s Internet Web site (xxx.xxxx.xx.xxx) has complaint forms, IMR application forms and in- structions instructions online. In the event that Blue Shield should cancel or re- fuse to renew your enrollment and you feel that such action was due to reasons of health or utiliza- tion utili- zation of benefits, you may request a review by the Department of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible re- sponsible for regulating health care ser- vice service plans. If you have a grievance against your health Planplan, you should first telephone your health Plan plan at the telephone number indicated on your Identification Card 0-000-000-0000 and use your health Planplan’s grievance process before contacting the Depart- mentDe- partment. Utilizing this grievance procedure does not prohibit prohib- it any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergencyemer- gency, a grievance that has not been satisfactorily resolved by your health Planplan, or a grievance that has remained unre- solved unresolved for more than 30 days, you may call the De- partment Department for assistanceassis- tance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity necessity of a proposed pro- posed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment pay- ment disputes for emergency or urgent medical Servicesservices. The De- partment Department also has a toll-free telephone number (0- 000-000-0000XXX-0000) and a TDD line (01-000877-000-0000688- 9891) for the hearing and speech impaired. The Depart- ment’s Internet Web site (xxx.xxxx.xx.xxxxxxx://xxx.xxxxxxx.xx.xxx) has complaint forms, IMR application forms and in- structions instructions online. In the event that Blue Shield of California should cancel or re- fuse refuse to renew the enrollment for you or your enrollment Dependents and you feel that such action was due to reasons of health or utiliza- tion utilization of benefits, you or your Dependents may request a review by the Department of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice service plans. If you have a grievance against your health Planplan, you should first telephone your health Plan plan at the telephone number indicated on your Identification Card 0-000-000-0000 and use your health Planplan’s grievance griev- ance process before contacting the Depart- mentDepartment. Utilizing Uti- lizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available avail- able to you. If you need help with a grievance involving involv- ing an emergency, a grievance that has not been satisfactorily sat- isfactorily resolved by your health Planplan, or a grievance griev- ance that has remained unre- solved unresolved for more than 30 days, you may call the De- partment Department for assistance. You may also be eligible for an Independent Medical Medi- cal Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity Medical Necessity of a proposed service or treatmenttreat- ment, coverage decisions for treatments that are experimental ex- perimental or investigational in nature nature, and payment disputes for emergency or urgent medical Servicesservices. The De- partment Department also has a toll-free telephone number num- ber (0- 0000-000-0000XXX-0000) and a TDD line (01-000877-000-0000688- 9891) for the hearing and speech impaired. The Depart- mentDe- partment’s Internet Web site site, (xxx.xxxx.xx.xxx) www.hmo- xxxx.xx.xxx), has complaint forms, IMR application forms forms, and in- structions instructions online. In the event that Blue Shield should cancel or re- fuse refuse to renew the enrollment for you or your enrollment Dependents and you feel that such action was due to reasons of health or utiliza- tion utilization of benefits, you or your Depen- dents may request a review by the Department of Managed Health Care Director.. Shield Concierge For questions about services, providers, Benefits, how to use this plan, or concerns regarding the qual- ity of care or access to care, contact Shield Concierge. Shield Concierge can answer many ques- tions over the telephone. Contact Information is pro- vided on the last page of this EOC. For all Mental Health and Substance Use Disorder Services Blue Shield has contracted with a Mental Health Service Administrator (MHSA). The MHSA should be contacted for questions about Mental Health and Substance Use Disorder Services, MHSA Participating Providers, or Mental Health and Sub- stance Use Disorder Benefits. Members may contact the MHSA at the telephone number or address which appear below: 0-000-000-0000 Blue Shield of California Mental Health Service Administrator X.X. Xxx 000000 Xxx Xxxxx, XX 00000-0000

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice plans. If you have a grievance against your health Planplan, you should first telephone your health Plan plan at the telephone number indicated on your Identification Card 0-000-000-0000 and use your health Planplan’s grievance process before contacting the Depart- ment. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health Planplan, or a grievance that has remained unre- solved for more than 30 days, you may call the De- partment for assistance. You may also be eligible for an Independent Medical Medi- cal Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity Medical Necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature nature, and payment disputes for emergency or urgent medical Servicesservices. The De- partment Department also has a toll-free telephone number (0- 0000-000-0000XXX-0000) and a TDD line (0-0- 000-000-0000) for the hearing and speech impairedim- paired. The Depart- mentDepartment’s Internet Web site site, (xxx.xxxx.xx.xxx) xxxx://xxx.xxxxxxx.xx.xxx), has complaint forms, IMR application forms forms, and in- structions onlineinstructions on- line. In the event that Blue Shield should cancel or re- fuse refuse to renew the enrollment for you or your enrollment De- pendents and you feel that such action was due to reasons of health or utiliza- tion utilization of benefits, you or your Dependents may request a review by the Department De- partment of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible re- sponsible for regulating health care ser- vice service plans. If you have a grievance against your health Planplan, you should first telephone your health Plan plan at the telephone number indicated on your Identification Card 0-000-000-0000 and use your health Planplan’s grievance process before contacting the Depart- mentDe- partment. Utilizing this grievance procedure does not prohibit pro- hibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving involv- ing an emergency, a grievance that has not been satisfactorily satisfactori- ly resolved by your health Planplan, or a grievance that has remained unre- solved re- mained unresolved for more than 30 days, you may call the De- partment Department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity med- ical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational investiga- tional in nature and payment disputes for emergency or urgent ur- gent medical Servicesservices. The De- partment Department also has a toll-free telephone number (0- 0000-000-0000XXX-0000) and a TDD line (0-000-000-0000) for the hearing and speech impairedim- paired. The Depart- mentDepartment’s Internet Web site (xxx.xxxx.xx.xxxxxxx://xxx.xxxxxxx.xx.xxx) has complaint forms, IMR application forms forms, and in- structions instructions online. In the event that Blue Shield of California should cancel or re- fuse refuse to renew the enrollment for you or your enrollment Dependents and you feel that such action was due to reasons of health or utiliza- tion utilization of benefits, you or your Dependents may request a review by the Department of Managed Health Care DirectorDirec- tor.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice plans. If you have a grievance against your health Planplan, you should first telephone your health Plan plan at the telephone number indicated on your Identification Card and use your health Planplan’s grievance process before contacting the Depart- ment. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health Planplan, or a grievance that has remained unre- solved un- resolved for more than 30 days, you may call the De- partment Department for assistance. You may also be eligible xxx- gible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity ne- cessity of a proposed service or treatment, coverage cover- age decisions for treatments that are experimental or investigational in nature nature, and payment disputes for emergency or urgent medical Services. The De- partment Department also has a toll-free telephone number (0- 0000-000-0000XXX-0000) and a TDD line (01-000877-000-0000688- 9891) for the hearing and speech impaired. The Depart- mentDepartment’s Internet Web site (xxx.xxxx.xx.xxxxxxx://xxx.xxxxxxx.xx.xxx) has complaint forms, IMR application forms and in- structions instructions online. In the event that Blue Shield should cancel or re- fuse to renew your enrollment and you feel that such action was due to reasons of health or utiliza- tion utili- zation of benefits, you may request a review by the Department of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice plans. If you have a grievance against your health Planplan, you should first telephone your health Plan plan at the telephone number indicated on your Identification Card 0-000-000-0000 and use your health Planplan’s grievance process before contacting the Depart- ment. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health Planplan, or a grievance that has remained unre- solved for more than 30 days, you may call the De- partment for assistance. You may also be eligible for an Independent Medical Medi- cal Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity Medical Necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature nature, and payment disputes for emergency or urgent medical Servicesservices. The De- partment Department also has a toll-free telephone number (0- 0-000-000-0000) and a TDD line (01-000877- 688-000-00009891) for the hearing and speech impaired. The Depart- mentDepartment’s Internet Web site internet website, (xxx.xxxx.xx.xxx) xxxx://xxx.xxxx.xx.xxx), has complaint forms, IMR application forms forms, and in- structions instructions online. In the event that Blue Shield should cancel or re- fuse refuse to renew the enrollment for you or your enrollment De- pendents and you feel that such action was due to reasons of health or utiliza- tion utilization of benefits, you or your Dependents may request a review by the Department De- partment of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice plans. If you have the Member has a grievance against your their health Planplan, you he or she should first telephone your the health Plan plan at the telephone number indicated on your Identification Card 0-000-000-0000 and use your the health Planplan’s grievance process before contacting the Depart- mentDe- partment. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to youthe Member. If you need the Mem- ber needs help with a grievance involving an emergencyemer- gency, a grievance that has not been satisfactorily resolved by your the health Planplan, or a grievance that has remained unre- solved unresolved for more than 30 days, you the Member may call the De- partment Department for assistance. You The Member may also be eligible for an Independent Indepen- dent Medical Review (IMR). If you are eligible the Member is xxxxx- ble for IMR, the IMR process will provide an impartial im- partial review of medical decisions made by a health plan related to the medical neces- sity Medical Necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational investiga- tional in nature nature, and payment disputes for emergency emer- gency or urgent medical Servicesservices. The De- partment Department also has a toll-free telephone number num- ber (0- 0000-000-0000XXX-0000) and a TDD line (01-000877- 688-000-00009891) for the hearing and speech impaired. The Depart- mentDepartment’s Internet Web site site, (xxx.xxxx.xx.xxx) www.hmo- xxxx.xx.xxx), has complaint forms, IMR application forms forms, and in- structions instructions online. In the event that Blue Shield should cancel or re- fuse refuse to renew your the enrollment for the Subscriber or their Dependents and you feel the Subscriber feels that such action ac- tion was due to reasons of health or utiliza- tion utilization of benefits, you the Subscriber or their Dependents may request a review by the Department of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice service plans. If you have a grievance against your health Planplan, you should first telephone your health Plan plan at the telephone number indicated on your Identification Card 0-000-000-0000 and use your health Planplan’s grievance griev- ance process before contacting the Depart- mentDepartment. Utilizing Uti- lizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available avail- able to you. If you need help with a grievance involving involv- ing an emergency, a grievance that has not been satisfactorily sat- isfactorily resolved by your health Planplan, or a grievance griev- ance that has remained unre- solved unresolved for more than 30 days, you may call the De- partment Department for assistance. You may also be eligible for an Independent Medical Medi- cal Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity Medical Necessity of a proposed service or treatmenttreat- ment, coverage decisions for treatments that are experimental ex- perimental or investigational in nature nature, and payment disputes for emergency or urgent medical Servicesservices. The De- partment Department also has a toll-free telephone number num- ber (0- 0000-000-0000XXX-0000) and a TDD line (01-000877-000-0000688- 9891) for the hearing and speech impaired. The Depart- mentDe- partment’s Internet Web site site, (xxx.xxxx.xx.xxx) www.hmo- xxxx.xx.xxx), has complaint forms, IMR application forms forms, and in- structions instructions online. In the event that Blue Shield should cancel or re- fuse refuse to renew the enrollment for you or your enrollment Dependents and you feel that such action was due to reasons of health or utiliza- tion utilization of benefits, you or your Depen- dents may request a review by the Department of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice service plans. If you have a grievance against your health Planplan, you should first telephone your health Plan plan at the telephone number indicated on your Identification Card and use your health Planplan’s grievance process before contacting the Depart- mentDepartment. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergencyemer- gency, a grievance that has not been satisfactorily satisfactori- ly resolved by your health Planplan, or a grievance that has remained unre- solved unresolved for more than 30 days, you may call the De- partment Department for assistanceassis- tance. You may also be eligible for an Independent Inde- pendent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity necessity of a proposed service or treatment, coverage decisions de- cisions for treatments that are experimental or investigational in nature nature, and payment disputes for emergency or urgent medical Services. The De- partment Department also has a toll-free telephone number num- ber (0- 0000-000-0000XXX-0000) and a TDD line (01-000877- 688-000-00009891) for the hearing and speech impaired. The Depart- mentDepartment’s Internet Web site (xxx.xxxx.xx.xxxxxxx://xxx.xxxxxxx.xx.xxx) has complaint forms, IMR application forms and in- structions instructions online. In the event that Blue Shield should cancel or re- fuse refuse to renew your enrollment and you feel that such action was due to reasons of health or utiliza- tion utilization of benefits, you may request a review by the Department of Managed Health Care DirectorXx- xxxxxx.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice service plans. If you have a grievance against your health Planplan, you should first telephone your health Plan plan at the telephone number indicated on your Identification Card 0-000-000-0000 and use your health Planplan’s grievance griev- ance process before contacting the Depart- mentDepartment. Utilizing Uti- lizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available avail- able to you. If you need help with a grievance involving involv- ing an emergency, a grievance that has not been satisfactorily sat- isfactorily resolved by your health Planplan, or a grievance griev- ance that has remained unre- solved unresolved for more than 30 days, you may call the De- partment Department for assistance. You may also be eligible for an Independent Medical Medi- cal Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity Medical Necessity of a proposed service or treatmenttreat- ment, coverage decisions for treatments that are experimental ex- perimental or investigational in nature nature, and payment disputes for emergency or urgent medical Servicesservices. The De- partment Department also has a toll-free telephone number num- ber (0- 0-000-000-0000) and a TDD line (01-000877-000-0000688- 9891) for the hearing and speech impaired. The Depart- mentDe- partment’s Internet Web site internet website, (xxx.xxxx.xx.xxx) ), has complaint forms, IMR application forms forms, and in- structions online. In the event that Blue Shield should cancel or re- fuse refuse to renew the enrollment for you or your enrollment Dependents and you feel that such action was due to reasons of health or utiliza- tion utilization of benefits, you or your Depen- dents may request a review by the Department of Managed Health Care Director.. Shield Concierge For questions about services, providers, Benefits, how to use this plan, or concerns regarding the qual- ity of care or access to care, contact Shield Concierge. Shield Concierge can answer many ques- tions over the telephone. Contact Information is pro- vided on the last page of this EOC. For all Mental Health and Substance Use Disorder Services Blue Shield has contracted with a Mental Health Service Administrator (MHSA). The MHSA should be contacted for questions about Mental Health and Substance Use Disorder Services, MHSA Participating Providers, or Mental Health and Sub- stance Use Disorder Benefits. Members may contact the MHSA at the telephone number or address which appear below: 0-000-000-0000 Blue Shield of California Mental Health Service Administrator X.X. Xxx 000000 Xxx Xxxxx, XX 00000-0000

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice plans. If you have a grievance against your health Plan, you should first telephone your health Plan at the telephone number indicated on your Identification Card and use your health Plan’s grievance process before contacting the Depart- ment. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health Plan, or a grievance that has remained unre- solved for more than 30 days, you may call the De- partment for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical Services. The De- partment also has a toll-free telephone number (0- 000-000-0000) and a TDD line (0-000-000-0000) for the hearing and speech impaired. The Depart- ment’s Internet Web site internet website (xxx.xxxx.xx.xxx) has complaint forms, IMR application forms and in- structions online. In the event that Blue Shield should cancel or re- fuse to renew your enrollment and you feel that such action was due to reasons of health or utiliza- tion of benefits, you may request a review by the Department of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice plans. If you have a grievance against your health Plan, you should first telephone your health Plan at the telephone number indicated on your Identification Card and use your health Plan’s grievance process before contacting the Depart- ment. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health Plan, or a grievance that has remained unre- solved un- resolved for more than 30 days, you may call the De- partment Department for assistance. You may also be eligible xxx- gible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity ne- cessity of a proposed service or treatment, coverage cover- age decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical Services. The De- partment Department also has a toll-free telephone number (0- 0000-000-0000XXX-0000) and a TDD line (01-000877-000-0000688- 9891) for the hearing and speech impaired. The Depart- mentDepartment’s Internet Web site (xxx.xxxx.xx.xxxxxxx://xxx.xxxxxxx.xx.xxx) has complaint forms, IMR application forms and in- structions instructions online. In the event that Blue Shield should cancel or re- fuse to renew your enrollment and you feel that such action was due to reasons of health or utiliza- tion utili- zation of benefits, you may request a review by the Department of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice service plans. If you have a grievance against your health Plan, you should first telephone your health Plan at the telephone number indicated on your Identification Card 1-800-424- 6521 and use your health Plan’s grievance process before be- fore contacting the Depart- mentDepartment. Utilizing this grievance griev- ance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health Plan, or a grievance that has remained unre- solved un- resolved for more than 30 days, you may call the De- partment for assistance. You may also be eligible for an Independent Medical Review independent medical review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions de- cisions made by a health plan related to the medical neces- sity ne- cessity of a proposed service or treatment, coverage decisions de- cisions for treatments that are experimental Experimental or investigational Investi- gational in nature Nature, and payment disputes for emergency emer- gency or urgent medical Servicesservices. The De- partment Department also has a toll-free telephone number (0- 0000-000-0000XXX-0000) and a TDD line (0-000-000-0000) for the hearing and speech impaired. The Depart- mentDepartment’s Internet Web site site, (xxx.xxxx.xx.xxx) xxxx://xxx.xxxxxxx.xx.xxx), has complaint forms, IMR application forms forms, and in- structions instructions online. In the event that Blue Shield should cancel or re- fuse refuse to renew the enrollment for you or your enrollment Dependents and you feel that such action was due to reasons of health or utiliza- tion utilization of benefitsBenefits, you or your Dependents may request a review by the Department of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible re- sponsible for regulating health care ser- vice service plans. If you have a grievance against your health Plan, you should first telephone tele- phone your health Plan at the telephone number indicated listed on your Identification Card the last pages of this booklet and use your health Plan’s grievance process before contacting the Depart- mentDepartment. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health Plan, or a grievance griev- ance that has remained unre- solved unresolved for more than 30 days, you may call the De- partment Department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity necessity of a proposed service ser- vice or treatment, coverage decisions for treatments that are experimental or investigational in nature nature, and payment disputes dis- putes for emergency or urgent medical Servicesservices. The De- partment Department also has a toll-free telephone number (0- 000-000-0000XXX-0000) and a TDD line (01-000877-000-0000688- 9891) for the hearing and speech impaired. The Depart- ment’s Internet Web site (xxx.xxxx.xx.xxxxxxx://xxx.xxxxxxx.xx.xxx) has complaint forms, IMR application forms forms, and in- structions instructions online. In the event that Blue Shield should cancel or re- fuse refuse to renew the enrollment for you or your enrollment Dependents and you feel that such action was due to reasons of health or utiliza- tion utilization of benefitsBenefits, you or your Dependents may request a review by the Department of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice plans. If you have a grievance against your health Planplan, you should first telephone your health Plan plan at the telephone number indicated on your Identification Card and use your health Planplan’s grievance process before contacting the Depart- ment. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health Planplan, or a grievance that has remained unre- solved un- resolved for more than 30 days, you may call the De- partment Department for assistance. You may also be eligible xxx- gible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity ne- cessity of a proposed service or treatment, coverage cover- age decisions for treatments that are experimental or investigational in nature nature, and payment disputes for emergency or urgent medical Services. The De- partment Department also has a toll-free telephone number (0- 0000-000-0000XXX-0000) and a TDD line (01-000877-000-0000688- 9891) for the hearing and speech impaired. The Depart- mentDepartment’s Internet Web site (xxx.xxxx.xx.xxxxxxx://xxx.xxxxxxx.xx.xxx) has complaint forms, IMR application forms forms, and in- structions instructions online. In the event that Blue Shield should cancel or re- fuse to renew your enrollment and you feel that such action was due to reasons of health or utiliza- tion utili- zation of benefits, you may request a review by the Department of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice service plans. If you have a grievance against your health Planplan, you should first telephone your health Plan plan at the telephone number indicated on your Identification Card 0-000-000-0000 and use your health Planplan’s grievance griev- ance process before contacting the Depart- mentDepartment. Utilizing Uti- lizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available avail- able to you. If you need help with a grievance involving involv- ing an emergency, a grievance that has not been satisfactorily sat- isfactorily resolved by your health Planplan, or a grievance griev- ance that has remained unre- solved unresolved for more than 30 days, you may call the De- partment Department for assistance. You may also be eligible for an Independent Medical Medi- cal Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical neces- sity Medical Necessity of a proposed service or treatmenttreat- ment, coverage decisions for treatments that are experimental ex- perimental or investigational in nature nature, and payment disputes for emergency or urgent medical Servicesservices. The De- partment Department also has a toll-free telephone number num- ber (0- 0-000-000-0000) and a TDD line (01-000877-000-0000688- 9891) for the hearing and speech impaired. The Depart- mentDe- partment’s Internet Web site internet website, (xxx.xxxx.xx.xxx) ), has complaint forms, IMR application forms forms, and in- structions online. In the event that Blue Shield should cancel or re- fuse refuse to renew the enrollment for you or your enrollment Dependents and you feel that such action was due to reasons of health or utiliza- tion utilization of benefits, you or your Depen- dents may request a review by the Department of Managed Health Care Director.

Department of Managed Health Care Review. The California Department of Managed Health Care is responsible for regulating health care ser- vice service plans. If you have a grievance against your health Plan, you should first telephone your health Plan at the telephone number indicated on your Identification Card 1-800-424- 6521 and use your health Plan’s grievance process before be- fore contacting the Depart- mentDepartment. Utilizing this grievance griev- ance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health Plan, or a grievance that has remained unre- solved un- resolved for more than 30 days, you may call the De- partment for assistance. You may also be eligible for an Independent Medical Review independent medical review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions de- cisions made by a health plan related to the medical neces- sity ne- cessity of a proposed service or treatment, coverage decisions de- cisions for treatments that are experimental Experimental or investigational Investi- gational in nature Nature, and payment disputes for emergency emer- gency or urgent medical Servicesservices. The De- partment Department also has a toll-free telephone number (0- 0000-000-0000XXX-0000) and a TDD line (0-000-000-0000) for the hearing and speech impaired. The Depart- mentDepartment’s Internet Web site site, (xxx.xxxx.xx.xxx) xxxx://xxx.xxxxxxx.xx.xxx), has complaint forms, IMR application forms forms, and in- structions instructions online. In the event that Blue Shield should cancel or re- fuse refuse to renew the enrollment for you or your enrollment Dependents and you feel that such action was due to reasons of health or utiliza- tion utilization of benefitsBenefits, you or your Dependents may request a review by the Department of Managed Health Care Director. CONTINUATION OF GROUP COVERAGE Please examine your options carefully before declining this coverage. You should be aware that companies selling individual health insurance typically require a review of your medical history that could result in a higher premium or you could be denied coverage en- tirely. Applicable to Members when the Subscriber’s Em- ployer (Contractholder) is subject to either Title X of the Consolidated Omnibus Budget Reconciliation Act (COBRA) as amended or the California Continuation Benefits Replacement Act (Cal-COBRA). The Sub- xxxxxxx’x Employer should be contacted for more infor- mation. In accordance with the Consolidated Omnibus Budget Reconciliation Act (COBRA) as amended and the Cali- fornia Continuation Benefits Replacement Act (Cal- COBRA), a Member will be entitled to elect to con- tinue group coverage under this Plan if the Member would otherwise lose coverage because of a Qualifying Event that occurs while the Contractholder is subject to the continuation of group coverage provisions of CO- BRA or Cal-COBRA. The Benefits under the group continuation of coverage will be identical to the Benefits that would be provided to the Member if the Qualifying Event had not occurred (including any changes in such coverage). Note: A Member will not be entitled to Benefits under Cal-COBRA if at the time of the qualifying event such Member is entitled to Benefits under Title XVIII of the Social Security Act (“Medicare”) or is covered under another group health plan that provides coverage with- out exclusions or limitations with respect to any Pre-ex- isting condition. Under COBRA, a Member is entitled to Benefits if at the time of the qualifying event such Mem- ber is entitled to Medicare or has coverage under an- other group health plan. However, if Medicare entitle- ment or coverage under another group health plan arises after COBRA coverage begins, it will cease.