Common use of Responsibility for Distribution and Notification Requirements Clause in Contracts

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 By Title 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. 000 00xx Xxxxxx Blue Shield of California Access+ HMO® Plan 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: W0053649-M0027196 Original Effective Date: January 1, 2015 GC-1

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 By Title 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. 000 00xx Xxxxxx Blue Shield of California Access+ HMO® Plan 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: W0053649W0071883-M0027196 M0029061 Original Effective Date: January 1, 2015 2021 GC-1

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 By Title 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. 000 00xx Xxxxxx Blue Shield of California Access+ HMO® Plan 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: W0053649-M0027196 M0026336 & M0026337 Original Effective Date: January 1, 2015 GC-1

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 By Title 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. 000 00xx Xxxxxx Blue Shield of California Access+ HMO® Plan 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, 20222021, for a term of 12 months, subject to the provisions entitled, “Changes: Entire Contract”. Group Number: W0053649W0071883-M0027196 M0025378 Original Effective Date: January 1, 2015 2021 GC-1

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 By Title 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. 000 00xx Xxxxxx Blue Shield of California Access+ HMO® Plan 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, 20222021, for a term of 12 months, subject to the provisions entitled, “Changes: Entire Contract”. Group Number: W0053649W0067301-M0027196 M0025188 Original Effective Date: January 1, 2015 2019 GC-1

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 By Title 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. 000 00xx Xxxxxx Blue Shield of California Access+ HMO® Plan 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: W0053649W0067301-M0027196 M0028386 & M0028387 Original Effective Date: January 1, 2015 2019 GC-1

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 By Title 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. 000 00xx Xxxxxx Blue Shield of California Access+ HMO® Plan 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: W0053649W0065302-M0027196 M0028180 Original Effective Date: January 1, 2015 2018 GC-1

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 By Title 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. 000 00xx Xxxxxx Blue Shield of California Access+ HMO® Plan 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: W0053649W0067301-M0027196 M0028385 Original Effective Date: January 1, 2015 2019 GC-1

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 By Title 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. 000 00xx Xxxxxx Blue Shield of California Access+ HMO® Plan 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, 20222021, for a term of 12 months, subject to the provisions entitled, “Changes: Entire Contract”. Group Number: W0053649W0070519-M0027196 M0024277 Original Effective Date: January 1, 2015 2020 GC-1

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 By Title 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. 000 00xx Xxxxxx Blue Shield of California Access+ HMO® Plan 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, 20222024, for a term of 12 months, subject to the provisions entitled, “Changes: Entire Contract”. Group Number: W0053649W0067449-M0027196 M0035338 Original Effective Date: January 1December 30, 2015 2018 GC-1

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 By Title 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. 000 00xx Xxxxxx Blue Shield of California Access+ HMO® Plan 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, 20222021, for a term of 12 months, subject to the provisions entitled, “Changes: Entire Contract”. Group Number: W0053649W0067301-M0027196 M0025189, M0025190 Original Effective Date: January 1, 2015 2019 GC-1