Common use of INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT Clause in Contracts

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 SECTION 2: ELIGIBILITY 15 SECTION 3: COVERED HEALTHCARE SERVICES 21 SECTION 4: EXCLUSIONS 49 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 SECTION 8: GLOSSARY 80 SECTION 9: CONTACT INFORMATION 88 SECTION 10: NOTICES AND DISCLOSURES 90 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 10 SECTION 2: ELIGIBILITY 15 14 SECTION 3: COVERED HEALTHCARE SERVICES 21 20 SECTION 4: EXCLUSIONS 49 48 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 58 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 66 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 73 SECTION 8: GLOSSARY 80 79 SECTION 9: CONTACT INFORMATION 88 87 SECTION 10: NOTICES AND DISCLOSURES 90 89 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 10 SECTION 2: ELIGIBILITY 15 14 SECTION 3: COVERED HEALTHCARE SERVICES 21 20 SECTION 4: EXCLUSIONS 49 45 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 55 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 63 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 70 SECTION 8: GLOSSARY 80 76 SECTION 9: CONTACT INFORMATION 88 84 SECTION 10: NOTICES AND DISCLOSURES 90 86 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 10 SECTION 2: ELIGIBILITY 15 14 SECTION 3: COVERED HEALTHCARE SERVICES 21 20 SECTION 4: EXCLUSIONS 49 48 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 58 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 65 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 72 SECTION 8: GLOSSARY 80 78 SECTION 9: CONTACT INFORMATION 88 86 SECTION 10: NOTICES AND DISCLOSURES 90 88 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 10 SECTION 2: ELIGIBILITY 15 14 SECTION 3: COVERED HEALTHCARE SERVICES 21 20 SECTION 4: EXCLUSIONS 49 45 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 55 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 63 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 70 SECTION 8: GLOSSARY 80 76 SECTION 9: CONTACT INFORMATION 88 83 SECTION 10: NOTICES AND DISCLOSURES 90 85 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 10 SECTION 2: ELIGIBILITY 15 14 SECTION 3: COVERED HEALTHCARE SERVICES 21 20 SECTION 4: EXCLUSIONS 49 48 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 58 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 66 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 72 SECTION 8: GLOSSARY 80 78 SECTION 9: CONTACT INFORMATION 88 86 SECTION 10: NOTICES AND DISCLOSURES 90 88 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 14 SECTION 2: ELIGIBILITY 15 18 SECTION 3: COVERED HEALTHCARE SERVICES 21 24 SECTION 4: EXCLUSIONS 49 54 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 64 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 71 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 79 SECTION 8: GLOSSARY 80 85 SECTION 9: CONTACT INFORMATION 88 93 SECTION 10: NOTICES AND DISCLOSURES 90 95 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 SECTION 2: ELIGIBILITY 15 SECTION 3: COVERED HEALTHCARE SERVICES 21 SECTION 4: EXCLUSIONS 49 45 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 55 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 63 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 71 SECTION 8: GLOSSARY 80 77 SECTION 9: CONTACT INFORMATION 88 84 SECTION 10: NOTICES AND DISCLOSURES 90 86 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 SECTION 2: ELIGIBILITY 15 SECTION 3: COVERED HEALTHCARE SERVICES 21 SECTION 4: EXCLUSIONS 49 47 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 57 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 65 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 72 SECTION 8: GLOSSARY 80 78 SECTION 9: CONTACT INFORMATION 88 85 SECTION 10: NOTICES AND DISCLOSURES 90 87 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 SECTION 2: ELIGIBILITY 15 SECTION 3: COVERED HEALTHCARE SERVICES 21 SECTION 4: EXCLUSIONS 49 48 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 58 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 66 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 72 SECTION 8: GLOSSARY 80 78 SECTION 9: CONTACT INFORMATION 88 86 SECTION 10: NOTICES AND DISCLOSURES 90 88 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 13 SECTION 2: ELIGIBILITY 15 17 SECTION 3: COVERED HEALTHCARE SERVICES 21 23 SECTION 4: EXCLUSIONS 49 53 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 63 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 70 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 77 SECTION 8: GLOSSARY 80 83 SECTION 9: CONTACT INFORMATION 88 91 SECTION 10: NOTICES AND DISCLOSURES 90 93 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 10 SECTION 2: ELIGIBILITY 15 14 SECTION 3: COVERED HEALTHCARE SERVICES 21 20 SECTION 4: EXCLUSIONS 49 48 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 58 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 65 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 73 SECTION 8: GLOSSARY 80 79 SECTION 9: CONTACT INFORMATION 88 87 SECTION 10: NOTICES AND DISCLOSURES 90 89 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 SECTION 2: ELIGIBILITY 15 SECTION 3: COVERED HEALTHCARE SERVICES 21 SECTION 4: EXCLUSIONS 49 45 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 55 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 63 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 70 SECTION 8: GLOSSARY 80 76 SECTION 9: CONTACT INFORMATION 88 83 SECTION 10: NOTICES AND DISCLOSURES 90 85 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 14 SECTION 2: ELIGIBILITY 15 18 SECTION 3: COVERED HEALTHCARE SERVICES 21 24 SECTION 4: EXCLUSIONS 49 52 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 62 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 70 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 78 SECTION 8: GLOSSARY 80 84 SECTION 9: CONTACT INFORMATION 88 92 SECTION 10: NOTICES AND DISCLOSURES 90 94 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 10 SECTION 2: ELIGIBILITY 15 14 SECTION 3: COVERED HEALTHCARE SERVICES 21 20 SECTION 4: EXCLUSIONS 49 44 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 54 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 62 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 70 SECTION 8: GLOSSARY 80 76 SECTION 9: CONTACT INFORMATION 88 83 SECTION 10: NOTICES AND DISCLOSURES 90 85 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 SECTION 2: ELIGIBILITY 15 SECTION 3: COVERED HEALTHCARE SERVICES 21 SECTION 4: EXCLUSIONS 49 51 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 61 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 69 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 76 SECTION 8: GLOSSARY 80 82 SECTION 9: CONTACT INFORMATION 88 90 SECTION 10: NOTICES AND DISCLOSURES 90 92 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 10 SECTION 2: ELIGIBILITY 15 14 SECTION 3: COVERED HEALTHCARE SERVICES 21 20 SECTION 4: EXCLUSIONS 49 46 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 56 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 63 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 69 SECTION 8: GLOSSARY 80 75 SECTION 9: CONTACT INFORMATION 88 83 SECTION 10: NOTICES AND DISCLOSURES 90 85 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 15 SECTION 2: ELIGIBILITY 15 19 SECTION 3: COVERED HEALTHCARE SERVICES 21 25 SECTION 4: EXCLUSIONS 49 53 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 63 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 71 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 79 SECTION 8: GLOSSARY 80 85 SECTION 9: CONTACT INFORMATION 88 93 SECTION 10: NOTICES AND DISCLOSURES 90 95 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 13 SECTION 2: ELIGIBILITY 15 18 SECTION 3: COVERED HEALTHCARE SERVICES 21 24 SECTION 4: EXCLUSIONS 49 51 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 61 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 68 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 SECTION 8: GLOSSARY 80 SECTION 9: CONTACT INFORMATION 88 SECTION 10: NOTICES AND DISCLOSURES 90 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 10 SECTION 2: ELIGIBILITY 15 14 SECTION 3: COVERED HEALTHCARE SERVICES 21 20 SECTION 4: EXCLUSIONS 49 45 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 54 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 61 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 66 SECTION 8: GLOSSARY 80 72 SECTION 9: CONTACT INFORMATION 88 80 SECTION 10: NOTICES AND DISCLOSURES 90 82 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 10 SECTION 2: ELIGIBILITY 15 14 SECTION 3: COVERED HEALTHCARE SERVICES 21 20 SECTION 4: EXCLUSIONS 49 47 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 57 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 65 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 72 SECTION 8: GLOSSARY 80 78 SECTION 9: CONTACT INFORMATION 88 86 SECTION 10: NOTICES AND DISCLOSURES 90 88 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 14 SECTION 2: ELIGIBILITY 15 18 SECTION 3: COVERED HEALTHCARE SERVICES 21 24 SECTION 4: EXCLUSIONS 49 51 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 61 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 69 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 77 SECTION 8: GLOSSARY 80 83 SECTION 9: CONTACT INFORMATION 88 90 SECTION 10: NOTICES AND DISCLOSURES 90 92 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 10 SECTION 2: ELIGIBILITY 15 14 SECTION 3: COVERED HEALTHCARE SERVICES 21 20 SECTION 4: EXCLUSIONS 49 47 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 57 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 64 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 72 SECTION 8: GLOSSARY 80 78 SECTION 9: CONTACT INFORMATION 88 86 SECTION 10: NOTICES AND DISCLOSURES 90 88 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 14 SECTION 2: ELIGIBILITY 15 18 SECTION 3: COVERED HEALTHCARE SERVICES 21 24 SECTION 4: EXCLUSIONS 49 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 75 SECTION 8: GLOSSARY 80 81 SECTION 9: CONTACT INFORMATION 88 89 SECTION 10: NOTICES AND DISCLOSURES 90 91 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 10 SECTION 2: ELIGIBILITY 15 14 SECTION 3: COVERED HEALTHCARE SERVICES 21 20 SECTION 4: EXCLUSIONS 49 45 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 54 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 62 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 68 SECTION 8: GLOSSARY 80 74 SECTION 9: CONTACT INFORMATION 88 81 SECTION 10: NOTICES AND DISCLOSURES 90 83 SUMMARY OF MEDICAL BENEFITS

INTRODUCTION TO YOUR SUBSCRIBER AGREEMENT. 11 14 SECTION 2: ELIGIBILITY 15 19 SECTION 3: COVERED HEALTHCARE SERVICES 21 25 SECTION 4: EXCLUSIONS 49 52 SECTION 5: REQUESTS FOR AUTHORIZATION, DENIALS, COMPLAINTS, AND APPEALS 59 62 SECTION 6: CLAIM FILING AND PROVIDER PAYMENTS 67 70 SECTION 7: COORDINATION OF BENEFITS AND SUBROGATION 74 76 SECTION 8: GLOSSARY 80 82 SECTION 9: CONTACT INFORMATION 88 90 SECTION 10: NOTICES AND DISCLOSURES 90 92 SUMMARY OF MEDICAL BENEFITS