Common use of Your Medical Group Clause in Contracts

Your Medical Group. Some PCPs contract directly with Blue Shield, but most are part of a Medical Group. Medical Groups: • Share administrative responsibilities with your PCP; • Work with your PCP to authorize Covered Services; • Ensure that a full panel of Specialists are available to you; and • Have admission arrangements with Blue Shield’s contracted Hospitals within the Medical Group Service Area. Your PCP and Medical Group are listed on your ID card. Changing your Medical Group You can change your Medical Group at any time. If your PCP is not part of your new Medical Group, you will also have to select a new PCP. Visit xxxxxxxxxxxx.xxx to change your Medical Group or PCP. Changes to your Medical Group are effective on the first day of the month after Blue Shield approves the change. At that time, authorizations for any services by your old Medical Group are no longer valid. If you still need these services, they must be reauthorized by your new Medical Group. Blue Shield does not recommend that you change your Medical Group while you are admitted to the Hospital or in the third trimester of pregnancy. A change in Medical Group during an ongoing course of treatment may interrupt your care. Any requested changes to your Medical Group in these situations will be effective on the first day of the month after the date when it is medically appropriate to transfer your care. Exceptions must be approved by a Blue Shield Medical Director. Call Customer Service for more information. Self-referral for obstetrical/gynecological (OB/GYN) services You do not need a referral from your PCP for OB/GYN services as long as the obstetrician, gynecologist, or family practice Physician you see is in your Medical Group. Your Cost Share for OB/GYN services with that Physician will be the same as if you received those services from your PCP. OB/GYN services are female reproductive and sexual health care services. OB/GYN services include Physician services related to: • Family planning and contraception; • Treatment during pregnancy; • Diagnosis and treatment of disorders of the female reproductive system and genitalia; • Treatment of disorders of the breast; and • HIV testing.

Your Medical Group. Some PCPs contract directly with Blue Shield, but most are part of a Medical Group. Medical Groups: •  Share administrative responsibilities with your PCP; •  Work with your PCP to authorize Covered Services; •  Ensure that a full panel of Specialists are available to you; and •  Have admission arrangements with Blue Shield’s contracted Hospitals within the Medical Group Service Area. Your PCP and Medical Group are listed on your ID card. Changing your Medical Group You can change your Medical Group at any time. If your PCP is not part of your new Medical Group, you will also have to select a new PCP. Visit xxxxxxxxxxxx.xxx to change your Medical Group or PCP. Changes to your Medical Group are effective on the first day of the month after Blue Shield approves the change. At that time, authorizations for any services by your old Medical Group are no longer valid. If you still need these services, they must be reauthorized by your new Medical Group. Blue Shield does not recommend that you change your Medical Group while you are admitted to the Hospital or in the third trimester of pregnancy. A change in Medical Group during an ongoing course of treatment may interrupt your care. Any requested changes to your Medical Group in these situations will be effective on the first day of the month after the date when it is medically appropriate to transfer your care. Exceptions must be approved by a Blue Shield Medical Director. Call Customer Service for more information. Self-referral for obstetrical/gynecological (OB/GYN) services You do not need a referral from your PCP for OB/GYN services as long as the obstetrician, gynecologist, or family practice Physician you see is in your Medical Group. Your Cost Share for OB/GYN services with that Physician will be the same as if you received those services from your PCP. OB/GYN services are female reproductive and sexual health care services. OB/GYN services include Physician services related to: •  Family planning and contraception; •  Treatment during pregnancy; •  Diagnosis and treatment of disorders of the female reproductive system and genitalia; •  Treatment of disorders of the breast; and •  HIV testing. Specialist referrals You have two options if you need to see a Specialist. PCP referrals This option requires a referral from your PCP to see most types of Specialist. Your PCP will refer you to a Specialist or other appropriate Participating Provider in your Medical Group. Self-referral to an Access+ Specialist With this option, you do not need a referral from your PCP to visit an Access+ Specialist in your Medical Group. You can self-refer to an Access+ Specialist for:  An examination or other consultation; and  In-office diagnostic procedures or treatment. You cannot self-refer to an Access+ Specialist for:  Allergy testing;  Endoscopic procedures;  Diagnostic and nuclear imaging, including CT, MRI, or bone density measurement;  Injectables, chemotherapy, or other infusion Drugs, other than vaccines and antibiotics;  Infertility services;  Inpatient services or any services that result in a facility charge, except for routine X-ray and laboratory services; or  Services for which the Medical Group routinely allows you to self-refer without authorization from your PCP. ID cards Blue Shield will provide the Subscriber and any enrolled Dependents with identification cards (ID cards). Only you can use your ID card to receive Benefits. Your ID card is important for accessing health care, so please keep it with you at all times. Temporary ID cards are available at xxxxxxxxxxxx.xxx or on the Blue Shield mobile app.

Your Medical Group. Some PCPs contract directly with Blue Shield, but most are part of a Medical Group. Medical Groups: •  Share administrative responsibilities with your PCP; •  Work with your PCP to authorize Covered Services; •  Ensure that a full panel of Specialists are available to you; and •  Have admission arrangements with Blue Shield’s contracted Hospitals within the Medical Group Service Area. Your PCP and Medical Group are listed on your ID card. Changing your Medical Group You can change your Medical Group at any time. If your PCP is not part of your new Medical Group, you will also have to select a new PCP. Visit xxxxxxxxxxxx.xxx to change your Medical Group or PCP. Changes to your Medical Group are effective on the first day of the month after Blue Shield approves the change. At that time, authorizations for any services by your old Medical Group are no longer valid. If you still need these services, they must be reauthorized by your new Medical Group. Blue Shield does not recommend that you change your Medical Group while you are admitted to the Hospital or in the third trimester of pregnancy. A change in Medical Group during an ongoing course of treatment may interrupt your care. Any requested changes to your Medical Group in these situations will be effective on the first day of the month after the date when it is medically appropriate to transfer your care. Exceptions must be approved by a Blue Shield Medical Director. Call Customer Service Shield Concierge for more information. Self-referral for obstetrical/gynecological (OB/GYN) services You do not need a referral from your PCP for OB/GYN services as long as the obstetrician, gynecologist, or family practice Physician you see is in your Medical Group. Your Cost Share for OB/GYN services with that Physician will be the same as if you received those services from your PCP. OB/GYN services are female reproductive and sexual health care services. OB/GYN services include Physician services related to: •  Family planning and contraception; •  Treatment during pregnancy; •  Diagnosis and treatment of disorders of the female reproductive system and genitalia; •  Treatment of disorders of the breast; and •  HIV testing. Specialist referrals You have two options if you need to see a Specialist. PCP referrals This option requires a referral from your PCP to see most types of Specialist. Your PCP will refer you to a Specialist or other appropriate Participating Provider in your Medical Group. Self-referral to a Trio+ Specialist With this option, you do not need a referral from your PCP to visit a Trio+ Specialist in your Medical Group. You can self-refer to a Trio+ Specialist for:  An examination or other consultation; and  In-office diagnostic procedures or treatment. You cannot self-refer to a Trio+ Specialist for:  Allergy testing;  Endoscopic procedures;  Diagnostic and nuclear imaging, including CT, MRI, or bone density measurement;  Injectables, chemotherapy, or other infusion Drugs, other than vaccines and antibiotics;  Infertility services;  Inpatient services or any services that result in a facility charge, except for routine X-ray and laboratory services; or  Services for which the Medical Group routinely allows you to self-refer without authorization from your PCP. ID cards Blue Shield will provide the Subscriber and any enrolled Dependents with identification cards (ID cards). Only you can use your ID card to receive Benefits. Your ID card is important for accessing health care, so please keep it with you at all times. Temporary ID cards are available at xxxxxxxxxxxx.xxx or on the Blue Shield mobile app.

Your Medical Group. Some PCPs contract directly with Blue Shield, but most are part of a Medical Group. Medical Groups: • Share administrative responsibilities with your PCP; • Work with your PCP to authorize Covered Services; • Ensure that a full panel of Specialists are available to you; and • Have admission arrangements with Blue Shield’s contracted Hospitals within the Medical Group Service Area. Your PCP and Medical Group are listed on your ID card. Changing your Medical Group You can change your Medical Group at any time. If your PCP is not part of your new Medical Group, you will also have to select a new PCP. Visit xxxxxxxxxxxx.xxx to change your Medical Group or PCP. Changes to your Medical Group are effective on the first day of the month after Blue Shield approves the change. At that time, authorizations for any services by your old Medical Group are no longer valid. If you still need these services, they must be reauthorized by your new Medical Group. Blue Shield does not recommend that you change your Medical Group while you are admitted to the Hospital or in the third trimester of pregnancy. A change in Medical Group during an ongoing course of treatment may interrupt your care. Any requested changes to your Medical Group in these situations will be effective on the first day of the month after the date when it is medically appropriate to transfer your care. Exceptions must be approved by a Blue Shield Medical Director. Call Customer Service Shield Concierge for more information. Self-referral for obstetrical/gynecological (OB/GYN) services You do not need a referral from your PCP for OB/GYN services as long as the obstetrician, gynecologist, or family practice Physician you see is in your Medical Group. Your Cost Share for OB/GYN services with that Physician will be the same as if you received those services from your PCP. OB/GYN services are female reproductive and sexual health care services. OB/GYN services include Physician services related to: • Family planning and contraception; • Treatment during pregnancy; • Diagnosis and treatment of disorders of the female reproductive system and genitalia; • Treatment of disorders of the breast; and • HIV testing.

Your Medical Group. Some PCPs contract directly with Blue Shield, but most are part of a Medical Group. Medical Groups: • Share administrative responsibilities with your PCP; • Work with your PCP to authorize Covered Services; • Ensure that a full panel of Specialists are available to you; and • Have admission arrangements with Blue Shield’s contracted Hospitals within the Medical Group Service Area. Your PCP and Medical Group are listed on your ID card. Changing your Medical Group You can change your Medical Group at any time. If your PCP is not part of your new Medical Group, you will also have to select a new PCP. Visit xxxxxxxxxxxx.xxx to change your Medical Group or PCP. Changes to your Medical Group are effective on the first day of the month after Blue Shield approves the change. At that time, authorizations for any services by your old Medical Group are no longer valid. If you still need these services, they must be reauthorized by your new Medical Group. Blue Shield does not recommend that you change your Medical Group while you are admitted to the Hospital or in the third trimester of pregnancy. A change in Medical Group during an ongoing course of treatment may interrupt your care. Any requested changes to your Medical Group in these situations will be effective on the first day of the month after the date when it is medically appropriate to transfer your care. Exceptions must be approved by a Blue Shield Medical Director. Call Customer Service Shield Concierge for more information. Self-referral for obstetrical/gynecological (OB/GYN) services You do not need a referral from your PCP for OB/GYN services as long as the obstetrician, gynecologist, or family practice Physician you see is in your Medical Group. Your Cost Share for OB/GYN services with that Physician will be the same as if you received those services from your PCP. OB/GYN services are female reproductive and sexual health care services. OB/GYN services include Physician services related to: • Family planning and contraception; • Treatment during pregnancy; • Diagnosis and treatment of disorders of the female reproductive system and genitalia; • Treatment of disorders of the breast; and • HIV testing. Specialist referrals You have two options if you need to see a Specialist. PCP referrals This option requires a referral from your PCP to see most types of Specialist. Your PCP will refer you to a Specialist or other appropriate Participating Provider in your Medical Group. Self-referral to a Trio+ Specialist With this option, you do not need a referral from your PCP to visit a Trio+ Specialist in your Medical Group. You can self-refer to a Trio+ Specialist for: • An examination or other consultation; and • In-office diagnostic procedures or treatment. You cannot self-refer to a Trio+ Specialist for: • Allergy testing; • Endoscopic procedures; • Diagnostic and nuclear imaging, including CT, MRI, or bone density measurement; • Injectables, chemotherapy, or other infusion Drugs, other than vaccines and antibiotics; • Infertility services; • Inpatient services or any services that result in a facility charge, except for routine X-ray and laboratory services; or • Services for which the Medical Group routinely allows you to self-refer without authorization from your PCP. ID cards Blue Shield will provide the Subscriber and any enrolled Dependents with identification cards (ID cards). Only you can use your ID card to receive Benefits. Your ID card is important for accessing health care, so please keep it with you at all times. Temporary ID cards are available at xxxxxxxxxxxx.xxx or on the Blue Shield mobile app.

Your Medical Group. Some PCPs contract directly with Blue Shield, but most are part of a Medical Group. Medical Groups: • Share administrative responsibilities with your PCP; • Work with your PCP to authorize Covered Services; • Ensure that a full panel of Specialists are available to you; and • Have admission arrangements with Blue Shield’s contracted Hospitals within the Medical Group Service Area. Your PCP and Medical Group are listed on your ID card. Changing your Medical Group You can change your Medical Group at any time. If your PCP is not part of your new Medical Group, you will also have to select a new PCP. Visit xxxxxxxxxxxx.xxx to change your Medical Group or PCP. Changes to your Medical Group are effective on the first day of the month after Blue Shield approves the change. At that time, authorizations for any services by your old Medical Group are no longer valid. If you still need these services, they must be reauthorized by your new Medical Group. Blue Shield does not recommend that you change your Medical Group while you are admitted to the Hospital or in the third trimester of pregnancy. A change in Medical Group during an ongoing course of treatment may interrupt your care. Any requested changes to your Medical Group in these situations will be effective on the first day of the month after the date when it is medically appropriate to transfer your care. Exceptions must be approved by a Blue Shield Medical Director. Call Customer Service for more information. Self-referral for obstetrical/gynecological (OB/GYN) services You do not need a referral from your PCP for OB/GYN services as long as the obstetrician, gynecologist, or family practice Physician you see is in your Medical Group. Your Cost Share for OB/GYN services with that Physician will be the same as if you received those services from your PCP. OB/GYN services are female reproductive and sexual health care services. OB/GYN services include Physician services related to: • Family planning and contraception; • Treatment during pregnancy; • Diagnosis and treatment of disorders of the female reproductive system and genitalia; • Treatment of disorders of the breast; and • HIV testing. Specialist referrals You have two options if you need to see a Specialist. PCP referrals This option requires a referral from your PCP to see most types of Specialist. Your PCP will refer you to a Specialist or other appropriate Participating Provider in your Medical Group. Self-referral to an Access+ Specialist With this option, you do not need a referral from your PCP to visit an Access+ Specialist in your Medical Group. You can self-refer to an Access+ Specialist for: • An examination or other consultation; and • In-office diagnostic procedures or treatment. You cannot self-refer to an Access+ Specialist for: • Allergy testing; • Endoscopic procedures; • Diagnostic and nuclear imaging, including CT, MRI, or bone density measurement; • Injectables, chemotherapy, or other infusion Drugs, other than vaccines and antibiotics; • Infertility services; • Inpatient services or any services that result in a facility charge, except for routine X-ray and laboratory services; or • Services for which the Medical Group routinely allows you to self-refer without authorization from your PCP. ID cards Blue Shield will provide the Subscriber and any enrolled Dependents with identification cards (ID cards). Only you can use your ID card to receive Benefits. Your ID card is important for accessing health care, so please keep it with you at all times. Temporary ID cards are available at xxxxxxxxxxxx.xxx or on the Blue Shield mobile app.