Responsibility for Distribution and Notification Requirements. Please see this section for important timelines for distribution of information. It is agreed that this application supersedes any previous application for this Contract. Dated at (City, State) this day of 20 (Legal Name of Contractholder) By Title PLEASE SIGN, DATE AND RETURN THE ORIGINAL APPLICATION PAGE TO BLUE SHIELD OF CALIFORNIA AT THE ABOVE ADDRESS. RETAIN THE CONTRACT. Inquiries concerning any problems that may develop in the administration of this Contract should be directed to Blue Shield of California at the address provided on page GC-1. GC-AP 0-00 000 00xx Xxxxxx Xxxxxxx, XX 00000 (000) 000-0000 GROUP HEALTH SERVICE CONTRACT Blue Shield of California Access+ HMO® Plan between Central California Alliance for Health (“Contractholder”) and California Physicians' Service dba Blue Shield of California a not-for-profit corporation In consideration of the applications and the timely payment of Dues, Blue Shield agrees to provide Benefits of this Contract to covered Employees and their covered Dependents. This Contract shall be effective as of January 1, 2022, for a term of 12 months, subject to the provisions entitled, “Changes: Entire Contract”. Group Number: W0071883-M0029061 Original Effective Date: January 1, 2021 GC-1 IMPORTANT
Responsibility for Distribution and Notification Requirements. The Contractholder has various distribution of notices and Member materials and other notification requirements under this Group Health Service Contract. Some of the major Contractholder distribution and notification requirements are summarized below; however, this is a summary only and is not to be construed as an all-inclusive list.
Responsibility for Distribution and Notification Requirements. Please see this section for important timelines for distribution of information. It is agreed that this application supersedes any previous application for this Contract. Dated at (City, State) this day of 20 (Legal Name of Contractholder) By Title PLEASE SIGN, DATE AND FAX THE ORIGINAL APPLICATION PAGE TO BLUE SHIELD OF CALIFORNIA AT: (000) 000-0000 or mail to Blue Shield of California, P.O. Box 629014, El Dorado Hills, CA 95762. Inquiries concerning any problems that may develop in the administration of this Contract should be directed to Blue Shield of California at the address provided on page GC-1. GC-AP 1-21 000 00xx Xxxxxx Oakland, CA 94607 (000) 000-0000 GROUP HEALTH SERVICE CONTRACT Blue Shield PPO + Child Dental between [Legal Name] (“Contractholder”) and California Physicians' Service dba Blue Shield of California a not-for-profit corporation In consideration of the applications and the timely payment of Premiums, Blue Shield agrees to provide Benefits of this Contract to covered Employees and their covered Dependents. This Contract shall be effective as of [Effective Date], for a term of 12 months, subject to the provisions entitled, “Changes: Entire Contract”.
Responsibility for Distribution and Notification Requirements. Please see this section for important timelines for distribution of information. It is agreed that this application supersedes any previous application for this Contract. Dated at (City, State) this day of 20 (Legal Name of Contractholder) By Title PLEASE SIGN, DATE AND RETURN THE ORIGINAL APPLICATION PAGE TO BLUE SHIELD OF CALIFORNIA AT THE ABOVE ADDRESS. RETAIN THE CONTRACT. Inquiries concerning any problems that may develop in the administration of this Contract should be directed to Blue Shield of California at the address provided on page GC-1.
Responsibility for Distribution and Notification Requirements. Contractholder may ensure electronic distribution of the EOC to Subscribers by one of the following methods: (1) by posting the EOC in a read-only format on an intranet site which is accessed by Employees of Contractholder; (2) by emailing the EOC directly to Subscribers; or (3) by providing Subscribers with Blue Shield’s instructions for accessing the EOC from the Blue Shield website. If Contractholder posts the electronic EOC on its intranet site, it shall do so in such a way so as to permit Employees of Contractholder to download and print a complete and accurate copy of the EOC. Contractholder will notify Employees enrolled with Blue Shield that the EOC for their plan is available to review, download and print from Contractholder’s intranet site, and will provide Subscribers with reasonable and appropriate instructions by which to access and print the document from its intranet site. Contractholder will provide a hard copy of the EOC to an Employee upon request. If Blue Shield receives an inquiry from an Employee of the Contractholder regarding obtaining a copy of the EOC, Blue Shield will refer that individual to Contractholder’s human resources benefits staff with instructions that a copy of the EOC is available from Contractholder on request. Contractholder has the option to request a supply of hard copies of the EOC in an amount not to exceed 10% of the total subscriber count at no additional charge. In the event Blue Shield reasonably concludes that Contractholder is either using the electronic EOC in a matter not permitted by this Agreement or is not providing Subscribers with access to the EOC in accordance herewith, then Blue Shield will print copies of the EOC, and Contractholder will cooperate with Blue Shield to ensure that printed copies of the EOC are timely provided to all Employees of Contractholder enrolled with Blue Shield. Contractholder agrees to reimburse Blue Shield for the reasonable cost of printing and delivering the EOC documents.
Responsibility for Distribution and Notification Requirements requirements of the Consolidated Omnibus Budget Reconciliation Act of 1985 [COBRA], as amended, apply to the Contractholder, are as set forth below:
