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 (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 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 Access+ HMO + Child Dental INF 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 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 Trio HMO + Child Dental INF 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 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 HMO + Child Dental INF 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”.