Common use of RIGHT TO EXAMINE AND CANCEL Clause in Contracts

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 GHI IND MKTHSA 1-22 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 CON-103.6 GHI IND MKTHSA OMKTHSAS 1-22 20 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 CON-103.7 GHI IND MKTHSA 1-22 21 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 GHI IND MKTHSA OMKTHSA 1-22 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 CON-103.6 GHI IND MKTHSA OMKTHSA 1-22 20 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 CON-103.7 GHI IND MKTHSA OMKTHSAS 1-22 21 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 CON-103.7 GHI IND MKTHSA OMKTHSA 1-22 21 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 CON-103.6 GHI IND MKTHSA OMKT 1-22 20 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 CON-103.7 GHI IND MKTHSA MKTS 1-22 21 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 GHI IND MKTHSA MKT 1-22 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 GHI IND MKTHSA OMKT 1-22 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 CON-103.7 GHI IND MKTHSA MKT 1-22 21 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 CON-103.6 GHI IND MKTHSA 1-22 20 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to GHI or an agent of GHI, no later than the tenth day after you receive this Contract. Notices may be delivered or sent to GHI Attn.: Membership Accounting, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309. Notice of cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the ten day time period shown above. GHI will return all payments made for this Contract, including fees or charges, within ten days after receipt of notice of cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by an insured prior to cancellation will be the member’s responsibility. CON-103.8 CON-103.6 GHI IND MKTHSA MKT 1-22 20 Statement of Nondiscrimination for Health Plan Members‌‌‌‌ Our Responsibilities: We follow Federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability or sex, including gender identity. • We help people with disabilities to communicate with us. This help is free. It includes: • Qualified sign language interpreters • Written information in other formats, such as large print, audio and accessible electronic formats • We provide services for people who do not speak English or who are not comfortable speaking English. These services are free. They include: • Qualified interpreters • Information written in other languages For Language or Communication Help: Call 0-000-000-0000 if you need language or other communication help. (TTY: 711) If you have questions about our non-discrimination policy: Contact the Civil Rights Coordinator at 0-000-000-0000 or xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx. To File a Grievance: If you believe that we have not provided these services or have discriminated against you because of your race, color, national origin, age, disability or sex, you can file a grievance by contacting the Civil Rights Coordinator at 0-000-000-0000, integrityandcompliance@ xxxxxxxxxxxxxx.xxx or Civil Rights Coordinator, Office of Integrity and Compliance, MS 21103K, 0000 00xx Xxx. S., Bloomington, MN 55425. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx. xxx.xxx/xxx/xxxxxx/xxxxx.xxx, or by mail or phone at: U.S. Department of Health and Human Services Room 509F, HHH Building 000 Xxxxxxxxxxxx Xxxxxx XX, Xxxxxxxxxx, XX 00000 1-800-368-1019, 000-000-0000 (TDD)