Common use of Service Area Clause in Contracts

Service Area. The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Bandera Xxxxxxxx Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Zandt Brazoria Xxxxxxx Xxxxxxxx Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxxxx Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxx Xxxxxxxx COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll free telephone number on the back of Your ID card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO

Service Area. The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Bandera Xxxxxxxx Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Zandt Brazoria Xxxxxxx Xxxxxxxx Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxxxx Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxx Coke Galveston Xxxxx Xxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxx Xxxxxxx Xxxxxx Xxxxxxxx COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll toll-free telephone number on the back of Your ID identification card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO

Service Area. The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. TX-G-H-NCC-COC-21 21 SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Angelina Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Concho Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Throckmorton Bandera Xxxxxxxx Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Baylor Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxx Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Deaf Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Bowie Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Van Zandt Brazoria Xxxxxxx Xxxxxxxx Hemphill Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Erath Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx San Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxxxx Cherokee Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Coke Xxxxxxx Xxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxxxx Xxxxx Xxxxxxxx COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll toll-free telephone number on the back of Your ID card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO

Service Area. The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Angelina Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Concho Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Throckmorton Bandera Xxxxxxxx Crockett Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Baylor Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxx Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Deaf Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Bowie Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Van Zandt Brazoria Xxxxxxx Xxxxxxxx Hemphill Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Erath Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx San Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxxxx Cherokee Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxx Coke Galveston Xxxxx Xxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxx Xxxxxxx Xxxxxx Xxxxxxxx COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll toll-free telephone number on the back of Your ID identification card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO

Service Area. The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Throckmorton Bandera Xxxxxxxx Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Zandt Brazoria Xxxxxxx Xxxxxxxx Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Erath Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxxxx Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxx Xxxxxxxx COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll free telephone number on the back of Your ID card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO

Service Area. The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Bandera Xxxxxxxx Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Zandt Brazoria Xxxxxxx Xxxxxxxx Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxxxx Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxx Coke Galveston Xxxxx Xxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxx Xxxxxxx Xxxxxx Xxxxxxxx COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll free telephone number on the back of Your ID card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO

Service Area. The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. TX-G-H-NCC-COC-21 21 SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Angelina Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Concho Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Bandera Xxxxxxxx Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Baylor Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxx Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Deaf Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Bowie Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Van Zandt Brazoria Xxxxxxx Xxxxxxxx Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Erath Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx San Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxxxx Cherokee Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Coke Xxxxxxx Xxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxxxx Xxxxx Xxxxxxxx COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll toll-free telephone number on the back of Your ID card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO

Service Area. The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Angelina Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Concho Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Bandera Xxxxxxxx Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Baylor Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxx Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Deaf Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Bowie Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Van Zandt Brazoria Xxxxxxx Xxxxxxxx Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Erath Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx San Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxxxx Cherokee Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxx Coke Galveston Xxxxx Xxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxx Xxxxxxx Xxxxxx Xxxxxxxx COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll toll-free telephone number on the back of Your ID identification card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO

Service Area. The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Angelina Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Concho Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Bandera Xxxxxxxx Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Baylor Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxx Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Deaf Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Bowie Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Van Zandt Brazoria Xxxxxxx Xxxxxxxx Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Erath Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx San Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxxxx Xxxxxx Cherokee Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxx Coke Galveston Xxxxx Xxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxx Xxxxxxx Xxxxxx Xxxxxxxx COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll free telephone number on the back of Your ID card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO

Service Area. Sample The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. Sample SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Bandera Xxxxxxxx Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Zandt Brazoria Xxxxxxx Xxxxxxxx Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxx Xxxxxxxx Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxx Xxxxxxxx COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll free telephone number on the back of Your ID card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO

Service Area. Service Area Sample The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. Sample SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Bandera Xxxxxxxx Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Zandt Brazoria Xxxxxxx Xxxxxxxx Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxxxx Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxx Xxxxxxxx MAP0511 26 COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll free telephone number on the back of Your ID card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO

Service Area. The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Angelina Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Concho Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Bandera Xxxxxxxx Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Baylor Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxx Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Deaf Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Bowie Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Van Zandt Brazoria Xxxxxxx Xxxxxxxx Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Erath Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx San Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxxxx Cherokee Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxx Coke Galveston Xxxxx Xxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxx Xxxxxxx Xxxxxx Xxxxxxxx COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll free telephone number on the back of Your ID card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO

Service Area. The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. Dallam Xxxxxxx Xxxxxxxxx Xxxxxxx Xxxxx Xxxxxxxx Xxxxxxx Xxxxxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Deaf Xxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxxx Xxxx Xxxxxxxxxxxxx Childress Xxxxxxxx Xxxxxx Xxxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxxx Wilbarger Wichita Lubbock Xxxxxxx Montague Xxxxxxx Xxxxxxx Hockley Xxxxxx King Xxxx Baylor Xxxxxx Xxxx Xxxxx Xxxxxx Xxxxx Red River Xxxxx Xxxx Xxxxx Xxxx Xxxxxxx Xxxxx Xxxx Xxxx Xxxxxx Xxxxxx Delta Xxxxxxxx Xxxx Xxxxxxx Xxxxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxxxxxxxxx Rockwall Camp Xxxx Xxxxxx Xxxxxx Xxxxxx Xxxxx Xxxxxxxx Palo Xxxxxxx Xxxxxx Xxxxxx Xxxxx Xxxx Xxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxxxxxxxxx Xxxxx Xxxxxxx Xxx Xxxxxx Xxxxx Xxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxxxxx Xxxxxxxx Hood Xxxxxxx Xxxxx Xxxxx Xxxxxxxxx Zandt Xxxxxxxxx Xxxxx Xxxx Panola El Paso Loving Xxxxxxx Xxxxx Xxxxxxxxx Coke Xxxxxxx Xxxxxxx Comanche Bosque Hill Navarro Cherokee Xxxxxxxx Xxxxxx Midland Xxxxxxxx Xxxxx Xxxxxxxx Xxxxxxxxx Nacogdoches Xxxxxxxx Xxxxxxxxx Xxxxxx Xxxx Xxxxx Xxxxx Xxxxxx Xxxxx Xxx Xxxxx Concho Xxxxx McLennan Xxxxxxx Limestone Xxxx Xxxxxxx San Xxxxxxxxx Xxxxxxxxxx XxXxxxxxx Xxxxxx San Saba Lampasas Burnet Xxxx Falls Xxxxxx RobertsonMadison Xxxxx Xxxxxxxx Trinity Xxxx Xxxxxx Xxxx Xxxxx Pecos Xxxxxxx Xxxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxxx Llano Xxxxxxxxx Xxxxxx Xxxxxxxxxx Xxxxxx Bastrop Brazos Xxxxxxxx Xxx Washington Xxxxxx San Xxxxxxx Xxxxxxxxxx Liberty Xxxxx Xxxxxx Orange Presidio Xxxxxxx Xxxx Xxxxxxx Xxxx Xxxxxx Xxx Verde Real Comal Xxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxx Xxxxxxxxx Xxxxxxxx Xxxxxxx Xxxxxxxxx Colorado Fort Bend Xxxxxx Uvalde Xxxxxx Bexar Xxxxxx Xxxxxxxx Lavaca Galveston Xxxxxxx Brazoria Maverick Atascosa De Xxxx Xxxxxxx Xxxxxx Frio XxXxxxxx Xxxxxx Goliad Xxxxxxxx Xxxxxxx Matagorda Dimmit La Salle Live Bee Oak Refugio Aransas Xxx San Xxxxxxxx Xxxx Xxxxx WellNs ueces Kleberg Xxxxxx Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxx 0 10M0AP114-ST Miles Xxxxxxx Xxxxxxx SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Angelina Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Concho Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Throckmorton Bandera Xxxxxxxx Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Baylor Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxx Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Deaf Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Bowie Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Van Zandt Brazoria Xxxxxxx Xxxxxxxx Hemphill Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Erath Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx San Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxxxx Cherokee Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Coke Xxxxxxx Xxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxxxx Xxxxx Xxxxxxxx COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll free telephone number on the back of Your ID card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO

Service Area. The Service Area covered by this Certificate includes the 254 counties on the map below and listed on the next page. SERVICE AREA Xxxxxxxx Xxxxxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxxxx Xxxxxxx Colorado Goliad Kenedy Nacogdoches Stonewall Xxxxxxxx Angelina Comal Xxxxxxxx Xxxx Xxxxxxx Xxxxxx Aransas Comanche Xxxx Xxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxx Concho Xxxxxxx Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Xxxxx Xxxxx Xxxx Nueces Xxxxxx Atascosa Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxxx Xxxxx Xxxx Xxxx Orange Xxxxxxxxxxxx Throckmorton Bandera Xxxxxxxx Xxxx La Salle Palo Xxxxx Xxxxx Bastrop Xxxxxx Xxxxxxxx Xxxxx Panola Xxx Xxxxx Xxxxxx Baylor Xxxxxxxxx Xxxxxxxx Xxxx Xxxxxx Xxxxxx Bee Xxxxxx Xxxxxxxx Lampasas Xxxxxx Trinity Bell Xxxx Xxxxxx Xxxxxx Lavaca Pecos Tyler Bexar Xxxxxx Xxxxxx Xxx Xxxx Xxxxxx Xxxxxx De Xxxx Xxxxxxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxx Deaf Xxxxx Xxxxxxx Liberty Presidio Uvalde Bosque Delta Xxxxxxx Limestone Xxxxx Xxx Verde Xxxxx Bowie Xxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxx Van Zandt Brazoria Xxxxxxx Xxxxxxxx Hemphill Live Oak Xxxxxx Xxxxxxxx Brazos Dimmit Xxxxxxxxx Llano Real Xxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Loving Red River Xxxxxx Xxxxxxx Xxxxx Xxxx Lubbock Xxxxxx Xxxx Xxxxxx Xxxxxxxx Xxxxxxx Xxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxx Hood Madison Xxxxxxx Xxxx Xxxxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxx Xxxxxxx Burnet El Paso Xxxxxxx Xxxxxx Rockwall Xxxxxxx Xxxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxxxx Wichita Xxxxxxx Xxxxx Erath Xxxxxxxx Matagorda Xxxx Wilbarger Xxxxxxxx Falls Xxxx Maverick Xxxxxx Xxxxxxx Xxxxxxx Xxxxxx Xxxxxxxxxx XxXxxxxxx Xxx San Xxxxxxxxx Xxxxxxxxxx Camp Xxxxxxx Xxxxx XxXxxxxx San Xxxxxxx Xxxxxx Xxxxxx Xxxxxx Xxxx XxXxxxxx San Xxxxxxxx Xxxxxxx Xxxx Xxxxx Xxxxxxx Xxxxxx San Xxxx Xxxx Xxxxxx Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxx Xxxx Xxxxxxxx Fort Bend Xxxx Xxxxx Midland Xxxxxx Yoakum Xxxxxxxx Cherokee Xxxxxxxx Xxxxxxxxx Xxxxx Xxxxxxxxxxx Xxxxx Childress Freestone Xxx Xxxx Xxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxx Frio Xxxxxx Xxx Xxxxx Xxxxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxx Xxxxxxx Xxxxxxxx Xxxxxxxx Xxxxx Coke Galveston Xxxxx Xxxxxxxxxx Xxxxxxxxx Xxxxxxx Xxxxx Xxxxxx Xxxx Xxxxxxx Xxxxxx Galveston Xxxxx Xxxxxxxxx Xxxxx Xxxxxx Xxxxxxx Xxxxxxxxxx Xxxxx Xxxxxx Xxxxxxxxx Xxxxx Xxxxxxx Xxxxxx Xxxxxxxx COMPLAINT AND APPEAL PROCEDURES Customer Inquiries You or a designated representative may direct inquiries to an HMO customer service representative by mail or by calling the toll free telephone number on the back of Your ID card. Inquiries resolved to Your satisfaction will be tracked by the HMO. If an inquiry is not resolved promptly to Your satisfaction, it will be handled according to the Complaint procedure described below. How to File a Complaint with the HMO