Common use of General Legal Provisions Clause in Contracts

General Legal Provisions. ‌ What Is Your Relationship with Us? It is important for you to understand our role with respect to this Policy and how it may affect you. We administer this Policy under which you are insured. We do not provide medical services or make treatment decisions. This means: • We communicate to you decisions about whether the Policy will cover or pay for the health care that you may receive. The Policy pays for Covered Health Care Services, which are more fully described in this Policy. • The Policy may not pay for all treatments you or your Physician may believe are needed. If the Policy does not pay, you will be responsible for the cost. We may use individually identifiable information about you to identify for you (and you alone) procedures, products or services that you may find valuable. We will use individually identifiable information about you as permitted or required by law, including in our operations and in our research. We will use de-identified data for commercial purposes including research. Please refer to our Notice of Privacy Practices for details. What Is Our Relationship with Providers? We have agreements in place that govern the relationship between us and Network Providers, some of which are affiliated providers. Network Providers enter into an agreement with us to provide Covered Health Care Services to Covered Persons. We do not provide health care services or supplies, or practice medicine. We arrange for health care providers to participate in a Network and we pay Benefits. Network Providers are independent practitioners who run their own offices and facilities. Our credentialing process confirms public information about the providers’ licenses and other credentials. It does not assure the quality of the services provided. We are not responsible for any act or omission of any provider.

General Legal Provisions. ‌ What Is Your Relationship with Us? It is important for you to understand our role with respect to this Policy and how it may affect you. We administer this Policy under which you are insured. We do not provide medical services or make treatment decisions. This means: • We communicate to you decisions about whether the Policy will cover or pay for the health care that you may receive. The Policy pays for Covered Health Care Services, which are more fully described in this Policy. • The Policy may not pay for all treatments you or your Physician may believe are needed. If the Policy does not pay, you will be responsible for the cost. We may use individually identifiable information about you to identify for you (and you alone) procedures, products or services that you may find valuable. We will use individually identifiable information about you as permitted or required by law, including in our operations and in our research. We will use de-identified data for commercial purposes including research. Please refer to our Notice of Privacy Practices for details. What Is Our Relationship with Providers? We have agreements in place that govern the relationship between us and Network Providers, some of which are affiliated providers. Network Providers enter into an agreement with us to provide Covered Health Care Services to Covered Persons. We do not provide health care services or supplies, or practice medicine. We arrange for health care providers to participate in a Network and we pay Benefits. Network Providers are independent practitioners who run their own offices and facilities. Our credentialing process confirms public information about the providers’ ' licenses and other credentials. It does not assure the quality of the services provided. We are not responsible for any act or omission of any provider.

General Legal Provisions. ‌ What Is Your Relationship with Us? It is important for you to understand our role with respect to this Policy and how it may affect you. We administer this Policy under which you are insured. We do not provide medical services or make treatment decisions. This means: • We communicate to you decisions about whether the Policy will cover or pay for the health care that you may receive. The Policy pays for Covered Health Care Services, which are more fully described in this Policy. • The Policy may not pay for all treatments you or your Physician may believe are needed. If the Policy does not pay, you will be responsible for the costthecost. We may use individually identifiable information about you to identify for you (and you alone) procedures, products or services that you may find valuable. We will use individually identifiable information about you as permitted or required by law, including in our operations and in our research. We will use de-identified data for commercial purposes including research. Please refer to our Notice of Privacy Practices for details. What Is Our Relationship with Providers? We have agreements in place that govern the relationship The relationships between us and Network Providers, some of which providers are affiliated providerssolely contractual relationships between independent contractors. Network Providers enter into an agreement with us to provide Covered Health Care Services to Covered Personsproviders are not our agents or employees. Neither we nor any of our employees are agents or employees of Network providers. We do not provide health care services or supplies, or practice medicine. We arrange for health care providers to participate in a Network and we pay Benefits. Network Providers providers are independent practitioners who run their own offices and facilities. Our credentialing process confirms public information about the providers’ ' licenses and other credentials. It does not assure the quality of the services provided. They are not our employees nor do we have any other relationship with Network providers such as principal-agent or joint venture. We are not responsible for any act or omission of any provider.

General Legal Provisions. ‌ What Is Your Relationship with Us? It is important for you to understand our role with respect to this Policy and how it may affect you. We administer this Policy under which you are insured. We do not provide medical services or make treatment decisions. This means: • We communicate to you decisions about whether the Policy will cover or pay for the health care that you may receive. The Policy pays for Covered Health Care Services, which are more fully described in this Policy. • The Policy may not pay for all treatments you or your Physician may believe are needed. If the Policy does not pay, you will be responsible for the cost. We may use individually identifiable information about you to identify for you (and you alone) procedures, products or services that you may find valuable. We will use individually identifiable information about you as permitted or required by law, including in our operations and in our research. We will use de-identified data for commercial purposes including research. Please refer to our Notice of Privacy Practices for details. What Is Our Relationship with Providers? We have agreements in place that govern the relationship between us and Network Providers, some of which are affiliated providers. Network Providers enter into an agreement with us to provide Covered Health Care Services to Covered Persons. SAMPLE We do not provide health care services or supplies, or practice medicine. We arrange for health care providers to participate in a Network and we pay Benefits. Network Providers are independent practitioners who run their own offices and facilities. Our credentialing process confirms public information about the providers’ ' licenses and other credentials. It does not assure the quality of the services provided. We are not responsible for any act or omission of any provider.

General Legal Provisions. ‌ What Is Your Relationship with Us? It is important for you to understand our role with respect to this Policy and how it may affect you. We administer this Policy under which you are insured. We do not provide medical services or make treatment decisions. This means: • We communicate to you decisions about whether the Policy will cover or pay for the health care that you may receive. The Policy pays for Covered Health Care Services, which are more fully described in this Policy. • The Policy may not pay for all treatments you or your Physician may believe are needed. If the Policy does not pay, you will be responsible for the cost. We may use individually identifiable information about you to identify for you (and you alone) procedures, products or services that you may find valuable. We will use individually identifiable information about you as permitted or required by law, including in our operations and in our research. We will use de-identified data for commercial purposes including research. Please refer to our Notice of Privacy Practices for details. SAMPLE What Is Our Relationship with Providers? We have agreements in place that govern the relationship The relationships between us and Network Providers, some of which providers are affiliated providerssolely contractual relationships between independent contractors. Network Providers enter into an agreement with us to provide Covered Health Care Services to Covered Personsproviders are not our agents or employees. Neither we nor any of our employees are agents or employees of Network providers. We do not provide health care services or supplies, or practice medicine. We arrange for health care providers to participate in a Network and we pay Benefits. Network Providers providers are independent practitioners who run their own offices and facilities. Our credentialing process confirms public information about the providers’ ' licenses and other credentials. It does not assure the quality of the services provided. They are not our employees nor do we have any other relationship with Network providers such as principal-agent or joint venture. We are not responsible for any act or omission of any provider.

General Legal Provisions. ‌ What Is Your Relationship with Us? It is important for you to understand our role with respect to this Policy and how it may affect you. We administer this Policy under which you are insured. We do not provide medical services or make treatment decisions. This means: •  We communicate to you decisions about whether the Policy will cover or pay for the health care that you may receive. The Policy pays for Covered Health Care Services, which are more fully described in this Policy. •  The Policy may not pay for all treatments you or your Physician may believe are needed. If the Policy does not pay, you will be responsible for the cost. We may use individually identifiable information about you to identify for you (and you alone) procedures, products or services that you may find valuable. We will use individually identifiable information about you as permitted or required by law, including in our operations and in our research. We will use de-identified data for commercial purposes including research. Please refer to our Notice of Privacy Practices for details. What Is Our Relationship with Providers? We have agreements in place that govern the relationship Sample The relationships between us and Network Providers, some of which providers are affiliated providerssolely contractual relationships between independent contractors. Network Providers enter into an agreement with us to provide Covered Health Care Services to Covered Personsproviders are not our agents or employees. Neither we nor any of our employees are agents or employees of Network providers. We do not provide health care services or supplies, or practice medicine. We arrange for health care providers to participate in a Network and we pay Benefits. Network Providers providers are independent practitioners who run their own offices and facilities. Our credentialing process confirms public information about the providers’ ' licenses and other credentials. It does not assure the quality of the services provided. They are not our employees nor do we have any other relationship with Network providers such as principal-agent or joint venture. We are not responsible for any act or omission of any provider.

General Legal Provisions. ‌ What Is Your Relationship with Us? It is important for you to understand our role with respect to this Policy and how it may affect you. We administer this Policy under which you are insured. We do not provide medical services or make treatment decisions. This means: • We communicate to you decisions about whether the Policy will cover or pay for the health care that you may receive. The Policy pays for Covered Health Care Services, which are more fully described in this Policy. • The Policy may not pay for all treatments you or your Physician may believe are needed. If the Policy does not pay, you will be responsible for the cost. We may use individually identifiable information about you to identify for you (and you alone) procedures, products or services that you may find valuable. We will use individually identifiable information about you as permitted or required by law, including in our operations and in our research. We will use de-identified data for commercial purposes including research. Please refer to our Notice of Privacy Practices for details. What Is Our Relationship with Providers? We have agreements in place that govern the relationship Sample The relationships between us and Network Providers, some of which providers are affiliated providerssolely contractual relationships between independent contractors. Network Providers enter into an agreement with us to provide Covered Health Care Services to Covered Personsproviders are not our agents or employees. Neither we nor any of our employees are agents or employees of Network providers. We do not provide health care services or supplies, or practice medicine. We arrange for health care providers to participate in a Network and we pay Benefits. Network Providers providers are independent practitioners who run their own offices and facilities. Our credentialing process confirms public information about the providers’ ' licenses and other credentials. It does not assure the quality of the services provided. They are not our employees nor do we have any other relationship with Network providers such as principal-agent or joint venture. We are not responsible for any act or omission of any provider.

General Legal Provisions. ‌ What Is Your Relationship with Us? It Us In order to make choices about your health care coverage and treatment, we believe that it is important for you to understand our role how we interact with respect to this Policy your Enrolling Group's Benefit plan and how it may affect you. We help finance or administer this Policy under the Enrolling Group's Benefit plan in which you are insuredenrolled. We do not provide medical services or make treatment decisions. This means: •  We communicate to you decisions about whether the Policy Enrolling Group's Benefit plan will cover or pay for the health care that you may receive. The Policy plan pays for Covered Health Care Services, which are more fully described in this PolicyCertificate. •  The Policy plan may not pay for all treatments you or your Physician may believe are needednecessary. If the Policy plan does not pay, you will be responsible for the cost. We may use individually identifiable information about you to identify for you (and you alone) procedures, products or services that you may find valuable. We will use individually identifiable information about you as permitted or required by law, including in our operations and in our research. We will use de-identified data for commercial purposes including research. Please refer to our Notice of Privacy Practices for details. What Is Our Relationship with Providers? We have agreements in place that govern the relationship Providers and Enrolling Groups The relationships between us and Network Providers, some of which providers and Enrolling Groups are affiliated providerssolely contractual relationships between independent contractors. Network Providers enter into an agreement with us to provide Covered Health Care Services to Covered Personsproviders and Enrolling Groups are not our agents or employees. Neither we nor any of our employees are agents or employees of Network providers or the Enrolling Groups. We do not provide health care services or supplies, or nor do we practice medicine. We Instead, we arrange for health care providers to participate in a Network and we pay Benefits. Network Providers providers are independent practitioners who run their own offices and facilities. Our credentialing process confirms public information about the providers’ ' licenses and other credentials. It , but does not assure the quality of the services provided. They are not our employees nor do we have any other relationship with Network providers such as principal-agent or joint venture. We are not responsible liable for any act or omission of any provider. We are not considered to be an employer for any purpose with respect to the administration or provision of benefits under the Enrolling Group's Benefit plan. We are not responsible for fulfilling any duties or obligations of an employer with respect to the Enrolling Group's Benefit plan. The Enrolling Group is solely responsible for all of the following:  Enrollment and classification changes (including classification changes resulting in your enrollment or the termination of your coverage).

General Legal Provisions. ‌ What Is Your Relationship with Us? It is important for you to understand our role with respect to this Policy and how it may affect you. We administer this Policy under which you are insured. We do not provide medical services or make treatment decisions. This means: • We communicate to you decisions about whether the Policy will cover or pay for the health care that you may receive. The Policy pays for Covered Health Care Services, which are more fully described in this Policy. • The Policy may not pay for all treatments you or your Physician may believe are needed. If the Policy does not pay, you will be responsible for the cost. We may use individually identifiable information about you to identify for you (and you alone) procedures, products or services that you may find valuable. We will use individually identifiable information about you as permitted or required by law, including in our operations and in our research. We will use de-identified data for commercial purposes including research. Please refer to our Notice of Privacy Practices for details. What Is Our Relationship with Providers? We have agreements in place that govern the relationship between us and Network Providersproviders, some of which are affiliated providers. Network Providers providers enter into an agreement with us to provide Covered Health Care Services to Covered Persons. SAMPLE We do not provide health care services or supplies, or practice medicine. We arrange for health care providers to participate in a Network and we pay Benefits. Network Providers providers are independent practitioners who run their own offices and facilities. Our credentialing process confirms public information about the providers’ ' licenses and other credentials. It does not assure the quality of the services provided. We are not responsible for any act or omission of any provider. What Is Your Relationship with Providers? The relationship between you and any provider is that of provider and patient. You are responsible for all of the following: • Choosing your own provider. • Paying, directly to your provider, any amount identified as a member responsibility, including Co-payments, Co- insurance, any deductible and any amount that exceeds the Allowed Amount, when applicable. • Paying, directly to your provider, the cost of any non-Covered Health Care Service. • Deciding if any provider treating you is right for you. This includes Network providers you choose and providers that they refer. • Deciding with your provider what care you should receive. Your provider is solely responsible for the quality of the services provided to you. Do We Pay Incentives to Providers? We pay Network providers through various types of contractual arrangements. Some of these arrangements may include financial incentives to promote the delivery of health care in a cost efficient and effective manner. These financial incentives are not intended to affect your access to health care. Examples of financial incentives for Network providers are: • Bonuses for performance based on factors that may include quality, member satisfaction and/or cost- effectiveness. • Capitation - a group of Network providers receives a monthly payment from us for each Covered Person who selects a Network provider within the group to perform or coordinate certain health care services. The Network providers receive this monthly payment regardless of whether the cost of providing or arranging to provide the Covered Person's health care is less than or more than the payment. • Bundled payments - certain Network providers receive a bundled payment for a group of Covered Health Care Services for a particular procedure or medical condition. Your Co-payment and/or Co-insurance will be calculated based on the provider type that received the bundled payment. The Network providers receive these bundled payments regardless of whether the cost of providing or arranging to provide the Covered Person's health care is less than or more than the payment. If you receive follow-up services related to a procedure where a bundled payment is made, an additional Co-payment and/or Co-insurance may not be required if such follow-up services are included in the bundled payment. You may receive some Covered Health Care Services that are not considered part of the inclusive bundled payment and those Covered Health Care Services would be subject to the applicable Co-payment and/or Co-insurance as described in your Schedule of Benefits. We use various payment methods to pay specific Network providers. From time to time, the payment method may change. If you have questions about whether your Network provider's contract with us includes any financial incentives, we encourage you to discuss those questions with your provider. You may also call us at the telephone number on your ID card. We can advise whether your Network provider is paid by any financial incentive, including those listed above. Are Incentives Available to You? SAMPLE Sometimes we may offer coupons, enhanced Benefits, or other incentives to encourage you to take part in various programs, including wellness programs, certain disease management programs, surveys, discount programs and/or programs to seek care in a more cost-effective setting and/or from Designated Providers. In some instances, these programs may be offered in combination with a non-UnitedHealthcare entity. The decision about whether or not to take part in a program is yours alone. However, we recommend that you discuss taking part in such programs with your Physician. We will notify you of the opportunity to participate in available programs and of any criteria for eligibility. Contact us at xxx.xxxxx.xxx/xxxxxxxx or the telephone number on your ID card if you have any questions. As determined by us, incentives may include, but are not limited to, the following: • A gym access or digital fitness class program. • Gift card incentives valued at a maximum of $500 for completing certain activities throughout the year, such as having a wellness visit with your Primary Care Physician or taking other plan communication-related actions (e.g., signing up for text messages or paperless communications). Do We Receive Rebates and Other Payments? We may receive rebates for certain drugs that are administered to you in your home or in a Physician's office, or at a Hospital or Alternate Facility. This includes rebates for those drugs that are administered to you before you meet any applicable deductible. As determined by us, we may pass a portion of these rebates on to you. When rebates are passed onto you, they may be taken into account in determining your Co-payment and/or Co-insurance.

General Legal Provisions. ‌ What Is Your Relationship with Us? It Us In order to make choices about your health care coverage and treatment, we believe that it is important for you to understand our role how we interact with respect to this Policy your Enrolling Group's Benefit plan and how it may affect you. We help finance or administer this Policy under the Enrolling Group's Benefit plan in which you are insuredenrolled. We do not provide medical services or make treatment decisions. This means: • We communicate to you decisions about whether the Policy Enrolling Group's Benefit plan will cover or pay for the health care that you may receive. The Policy plan pays for Covered Health Care Services, which are more fully described in this PolicyCertificate. • The Policy plan may not pay for all treatments you or your Physician may believe are needednecessary. If the Policy plan does not pay, you will be responsible for the cost. We may use individually identifiable information about you to identify for you (and you alone) procedures, products or services that you may find valuable. We will use individually identifiable information about you as permitted or required by law, including in our operations and in our research. We will use de-identified data for commercial purposes including research. Please refer to our Notice of Privacy Practices for details. What Is Our Relationship with Providers? We have agreements in place that govern the relationship Providers and Enrolling Groups The relationships between us and Network Providers, some of which providers and Enrolling Groups are affiliated providerssolely contractual relationships between independent contractors. Network Providers enter into an agreement with us to provide Covered Health Care Services to Covered Personsproviders and Enrolling Groups are not our agents or employees. Neither we nor any of our employees are agents or employees of Network providers or the Enrolling Groups. We do not provide health care services or supplies, or nor do we practice medicine. We Instead, we arrange for health care providers to participate in a Network and we pay Benefits. Network Providers providers are independent practitioners who run their own offices and facilities. Our credentialing process confirms public information about the providers’ ' licenses and other credentials. It , but does not assure the quality of the services provided. They are not our employees nor do we have any other relationship with Network providers such as principal-agent or joint venture. We are not responsible liable for any act or omission of any provider. We are not considered to be an employer for any purpose with respect to the administration or provision of benefits under the Enrolling Group's Benefit plan. We are not responsible for fulfilling any duties or obligations of an employer with respect to the Enrolling Group's Benefit plan. The Enrolling Group is solely responsible for all of the following: • Enrollment and classification changes (including classification changes resulting in your enrollment or the termination of your coverage).

General Legal Provisions. ‌ What Is Your Relationship with Us? It is important for you to understand our role with respect to this Policy and how it may affect you. We administer this Policy under which you are insured. We do not provide medical services or make treatment decisions. This means: • We communicate to you decisions about whether the Policy will cover or pay for the health care that you may receive. The Policy pays for Covered Health Care Services, which are more fully described in this Policy. • The Policy may not pay for all treatments you or your Physician may believe are needed. If the Policy does not pay, you will be responsible for the cost. We may use individually identifiable information about you to identify for you (and you alone) procedures, products or services that you may find valuable. We will use individually identifiable information about you as permitted or required by law, including in our operations and in our research. We will use de-identified data for commercial purposes including research. Please refer to our Notice of Privacy Practices for details. What Is Our Relationship with Providers? We have agreements in place that govern the relationship between us and Network Providersproviders, some of which are affiliated providers. Network Providers providers enter into an agreement with us to provide Covered Health Care Services to Covered Persons. SAMPLE We do not provide health care services or supplies, or practice medicine. We arrange for health care providers to participate in a Network and we pay Benefits. Network Providers providers are independent practitioners who run their own offices and facilities. Our credentialing process confirms public information about the providers’ ' licenses and other credentials. It does not assure the quality of the services provided. We are not responsible for any act or omission of any provider.