Common use of Packaged Plan Clause in Contracts

Packaged Plan. This health plan is part of a package that consists of a health plan and a dental plan which is offered at a package rate. This Evidence of Coverage and Health Service Agreement describes the benefits of the health plan as part of the package Notice About Plan Benefits: No person has the right to receive the Benefits of this plan for services or supplies furnished following termination of coverage. Benefits of this plan are available only for services and supplies furnished during the term it is in effect and while the individual claiming Benefits is actually covered by this Agreement. Benefits may be modified during the term of this plan as specifically provided under the terms of this Agreement or upon renewal. If Benefits are modified, the revised Benefits (including any reduction in Benefits or the elimination of Benefits) apply for services or supplies furnished on or after the effective date of the modification. There is no vested right to receive the Benefits of this Agreement. Notice About Reproductive Health Services: Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you enroll. Call your prospective doctor, medical group, independent practice association, or clinic, or call the health plan at Blue Shield’s Customer Service telephone number provided on the back page of this Evidence of Coverage and Health Service Agreement to ensure that you can obtain the health care services that you need. Notice About Contracted Providers: Blue Shield contracts with Hospitals and Physicians to provide services to Members for specified rates. This contractual agreement may include incentives to manage all services for Members in an appropriate manner consistent with the contract. To learn more about this payment system contact Customer Service. Notice About Health Information Exchange Participation: Blue Shield participates in the California Integrated Data Exchange (Cal INDEX) Health Information Exchange (“HIE”) making its Members’ health information available to Cal INDEX for access by their authorized health care providers. Cal INDEX is an independent, not-for-profit organization that maintains a statewide database of electronic patient records that includes health information contributed by doctors, health care facilities, health care service plans, and health insurance companies. Authorized health care providers (including doctors, nurses, and hospitals) may securely access their patients’ health information through the Cal INDEX HIE to support the provision of safe, high-quality care. Cal INDEX respects Members’ right to privacy and follows applicable state and federal privacy laws. Cal INDEX uses advanced security systems and modern data encryption techniques to protect Members’ privacy and the security of their personal information. The Cal INDEX notice of privacy practices is posted on its website at xxx.xxxxxxxx.xxx. Every Blue Shield Member has the right to direct Cal INDEX not to share their health information with their health care providers. Although opting out of Cal INDEX may limit your health care provider’s ability to quickly access important health care information about you, a Member’s health insurance or health plan benefit coverage will not be affected by an election to opt-out of Cal INDEX. No doctor or hospital participating in Cal INDEX will deny medical care to a patient who chooses not to participate in the Cal INDEX HIE. Members who do not wish to have their healthcare information displayed in Cal INDEX, should fill out the online form at xxx.xxxxxxxx.xxx/xxx-xxx or call Cal INDEX at (000) 000-0000. Blue Shield of California

Packaged Plan. This health plan is part of a package that consists of a health plan and a dental plan which is offered at a package rate. This Evidence of Coverage and Health Service Agreement describes the benefits of the health plan as part of the package Notice About Plan Benefits: No person has the right to receive the Benefits of this plan for services or supplies furnished following termination of coverage. Benefits of this plan are available only for services and supplies furnished during the term it is in effect and while the individual claiming Benefits is actually covered by this Agreement. Benefits may be modified during the term of this plan as specifically provided under the terms of this Agreement or upon renewal. If Benefits are modified, the revised Benefits (including any reduction in Benefits or the elimination of Benefits) apply for services or supplies furnished on or after the effective date of the modification. There is no vested right to receive the Benefits of this Agreement. IFPPPOEOCJ14 IFPPPOEOCJ14 Notice About Reproductive Health Services: Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you enroll. Call your prospective doctor, medical group, independent practice association, or clinic, or call the health plan at Blue Shield’s Customer Service telephone number provided on the back page of this Evidence of Coverage and Health Service Agreement to ensure that you can obtain the health care services that you need. Notice About Contracted Providers: Blue Shield contracts with Hospitals and Physicians to provide services to Members for specified rates. This contractual agreement may include incentives to manage all services for Members in an appropriate manner consistent with the contract. To learn more about this payment system contact Customer Service. Notice About Health Information Exchange Participation: Blue Shield participates in the California Integrated Data Exchange (Cal INDEX) Health Information Exchange (“HIE”) making its Members’ health information available to Cal INDEX for access by their authorized health care providers. Cal INDEX is an independent, not-for-profit organization that maintains a statewide database of electronic patient records that includes health information contributed by doctors, health care facilities, health care service plans, and health insurance companies. Authorized health care providers (including doctors, nurses, and hospitals) may securely access their patients’ health information through the Cal INDEX HIE to support the provision of safe, high-quality care. Cal INDEX respects Members’ right to privacy and follows applicable state and federal privacy laws. Cal INDEX uses advanced security systems and modern data encryption techniques to protect Members’ privacy and the security of their personal information. The Cal INDEX notice of privacy practices is posted on its website at xxx.xxxxxxxx.xxx. Every Blue Shield Member has the right to direct Cal INDEX not to share their health information with their health care providers. Although opting out of Cal INDEX may limit your health care provider’s ability to quickly access important health care information about you, a Member’s health insurance or health plan benefit coverage will not be affected by an election to opt-out of Cal INDEX. No doctor or hospital participating in Cal INDEX will deny medical care to a patient who chooses not to participate in the Cal INDEX HIE. Members who do not wish to have their healthcare information displayed in Cal INDEX, should fill out the online form at xxx.xxxxxxxx.xxx/xxx-xxx or call Cal INDEX at (000) 000-0000. Blue Shield of California

Packaged Plan. This health plan is part of a package that consists of a health plan and a dental plan which is offered at a package rate. This Evidence of Coverage and Health Service Agreement describes the benefits of the health plan as part of the package Notice About Plan Benefits: No person has the right to receive the Benefits of this plan for services or supplies furnished following termination of coverage. Benefits of this plan are available only for services and supplies furnished during the term it is in effect and while the individual claiming Benefits is actually covered by this Agreement. Benefits may be modified during the term of this plan as specifically provided under the terms of this Agreement or upon renewal. If Benefits are modified, the revised Benefits (including any reduction in Benefits or the elimination of Benefits) apply for services or supplies furnished on or after the effective date of the modification. There is no vested right to receive the Benefits of this Agreement. Notice About Reproductive Health Services: Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility IFPPPOEOCJ14 IFPPPOCATEOCJ14 treatments; or abortion. You should obtain more information before you enroll. Call your prospective doctor, medical group, independent practice association, or clinic, or call the health plan at Blue Shield’s Customer Service telephone number provided on the back page of this Evidence of Coverage and Health Service Agreement to ensure that you can obtain the health care services that you need. Notice About Contracted Providers: Blue Shield contracts with Hospitals and Physicians to provide services to Members for specified rates. This contractual agreement may include incentives to manage all services for Members in an appropriate manner consistent with the contract. To learn more about this payment system contact Customer Service. Notice About Health Information Exchange Participation: Blue Shield participates in the California Integrated Data Exchange (Cal INDEX) Health Information Exchange (“HIE”) making its Members’ health information available to Cal INDEX for access by their authorized health care providers. Cal INDEX is an independent, not-for-profit organization that maintains a statewide database of electronic patient records that includes health information contributed by doctors, health care facilities, health care service plans, and health insurance companies. Authorized health care providers (including doctors, nurses, and hospitals) may securely access their patients’ health information through the Cal INDEX HIE to support the provision of safe, high-quality care. Cal INDEX respects Members’ right to privacy and follows applicable state and federal privacy laws. Cal INDEX uses advanced security systems and modern data encryption techniques to protect Members’ privacy and the security of their personal information. The Cal INDEX notice of privacy practices is posted on its website at xxx.xxxxxxxx.xxx. Every Blue Shield Member has the right to direct Cal INDEX not to share their health information with their health care providers. Although opting out of Cal INDEX may limit your health care provider’s ability to quickly access important health care information about you, a Member’s health insurance or health plan benefit coverage will not be affected by an election to opt-out of Cal INDEX. No doctor or hospital participating in Cal INDEX will deny medical care to a patient who chooses not to participate in the Cal INDEX HIE. Members who do not wish to have their healthcare information displayed in Cal INDEX, should fill out the online form at xxx.xxxxxxxx.xxx/xxx-xxx or call Cal INDEX at (000) 000-0000. Blue Shield of California

Packaged Plan. This health plan is part of a package that consists of a health plan and a dental plan which is offered at a package rate. This Evidence of Coverage and Health Service Agreement describes the benefits of the health plan as part of the package Notice About Plan Benefits: No person has the right to receive the Benefits of this plan for services or supplies furnished following termination of coverage. Benefits of this plan are available only for services and supplies furnished during the term it is in effect and while the individual claiming Benefits is actually covered by this Agreement. Benefits may be modified during the term of this plan as specifically provided under the terms of this Agreement or upon renewal. If Benefits are modified, the revised Benefits (including any reduction in Benefits or the elimination of Benefits) apply for services or supplies furnished on or after the effective date of the modification. There is no vested right to receive the Benefits of this Agreement. IFPPPOEOCJ15 IFPPPOEOCJ15 Notice About Reproductive Health Services: Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you enroll. Call your prospective doctor, medical group, independent practice association, or clinic, or call the health plan at Blue Shield’s Customer Service telephone number provided on the back page of this Evidence of Coverage and Health Service Agreement to ensure that you can obtain the health care services that you need. Notice About Contracted Providers: Blue Shield contracts with Hospitals and Physicians to provide services to Members for specified rates. This contractual agreement may include incentives to manage all services for Members in an appropriate manner consistent with the contract. To learn more about this payment system contact Customer Service. Notice About Health Information Exchange Participation: Blue Shield participates in the California Integrated Data Exchange (Cal INDEX) Health Information Exchange (“HIE”) making its Members’ health information available to Cal INDEX for access by their authorized health care providers. Cal INDEX is an independent, not-for-profit organization that maintains a statewide database of electronic patient records that includes health information contributed by doctors, health care facilities, health care service plans, and health insurance companies. Authorized health care providers (including doctors, nurses, and hospitals) may securely access their patients’ health information through the Cal INDEX HIE to support the provision of safe, high-quality care. Cal INDEX respects Members’ right to privacy and follows applicable state and federal privacy laws. Cal INDEX uses advanced security systems and modern data encryption techniques to protect Members’ privacy and the security of their personal information. The Cal INDEX notice of privacy practices is posted on its website at xxx.xxxxxxxx.xxx. Every Blue Shield Member has the right to direct Cal INDEX not to share their health information with their health care providers. Although opting out of Cal INDEX may limit your health care provider’s ability to quickly access important health care information about you, a Member’s health insurance or health plan benefit coverage will not be affected by an election to opt-out of Cal INDEX. No doctor or hospital participating in Cal INDEX will deny medical care to a patient who chooses not to participate in the Cal INDEX HIE. Members who do not wish to have their healthcare information displayed in Cal INDEX, should fill out the online form at xxx.xxxxxxxx.xxx/xxx-xxx or call Cal INDEX at (000) 000-0000. Blue Shield of California