Common use of Plan Interpretation Clause in Contracts

Plan Interpretation. Blue Shield shall have the power and authority to construe and interpret the provisions of this Plan, to determine the Benefits of this Plan and deter- mine eligibility to receive Benefits under this Plan. Blue Shield shall exercise this authority for the benefit of all Members entitled to receive Benefits under this Plan. Public Policy Participation Procedure This procedure enables Members to participate in establishing the public policy of Blue Shield. It is not to be used as a substitute for the grievance pro- cedure, complaints, inquiries or requests for infor- mation. Public policy means acts performed by a plan or its employees and staff to assure the comfort, dignity, and convenience of patients who rely on the plan’s facilities to provide health care services to them, their families, and the public (California Health and Safety Code, §1369). At least one third of the Board of Directors of Blue Shield is comprised of Subscribers who are not employees, providers, subcontractors or group contract brokers and who do not have financial in- terests in Blue Shield. The names of the members of the Board of Directors may be obtained from: Sr. Manager, Regulatory Filings Blue Shield of California 00 Xxxxx Xxxxxx San Francisco, CA 94105 Phone: 0-000-000-0000 Please follow the following procedure:

Plan Interpretation. Blue Shield shall have the power and authority to construe and interpret the provisions of this Plan, to determine the Benefits of this Plan and deter- mine eligibility to receive Benefits under this Plan. Blue Shield shall exercise this authority for the benefit of all Members entitled to receive Benefits under this Plan. Public Policy Participation Procedure This procedure enables Members to participate in establishing the public policy of Blue Shield. It is not to be used as a substitute for the grievance pro- cedure, complaints, inquiries or requests for infor- mation. Public policy means acts performed by a plan or its employees and staff to assure the comfort, dignity, and convenience of patients who rely on the plan’s facilities to provide health care services to them, their families, and the public (California Health and Safety Code, §1369). At least one third of the Board of Directors of Blue Shield is comprised of Subscribers who are not employees, providers, subcontractors or group contract brokers and who do not have financial in- terests in Blue Shield. The names of the members of the Board of Directors may be obtained from: Sr. Manager, Regulatory Filings Blue Shield of California 00 Xxxxx 000 00xx Xxxxxx San FranciscoXxxxxxx, CA 94105 XX 00000 Phone: 0-000-000-0000 Please follow the following procedure: