Group Subscriber Agreement Sample Contracts

Group Subscriber Agreement and Guide to Your Managed Care Plan
Group Subscriber Agreement • January 29th, 2024

This Section explains your rights and responsibilities under this Agreement and how you can participate on our Consumer Advisory Board.

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Group Subscriber Agreement Combined Evidence of Coverage And
Group Subscriber Agreement • January 2nd, 2024

This Group Subscriber Agreement, Combined Evidence of Coverage and Disclosure Form contains the exact terms and conditions of coverage for the California Dental Network Children’s Dental HMO.

Presbyterian Health Plan, Inc.
Group Subscriber Agreement • July 17th, 2022
Group Subscriber Agreement Combined Evidence of Coverage And
Group Subscriber Agreement • August 3rd, 2022

This Group Subscriber Agreement, Combined Evidence of Coverage and Disclosure Form contains the exact terms and conditions of coverage for the California Dental Network Children’s Dental HMO.

Group Subscriber Agreement and Guide to Your Preferred Provider Organization (PPO) HDHP Plan
Group Subscriber Agreement • November 11th, 2021

THIS ENDORSEMENT MAY CHANGE YOUR AGREEMENT WITH US. IF THE TERMS OF THIS ENDORSEMENT CONFLICT WITH ANY INFORMATION IN YOUR EOC, THE TERMS OF THIS ENDORSEMENT CONTROL.

Group Subscriber Agreement Combined Evidence of Coverage And
Group Subscriber Agreement • July 31st, 2020

This Group Subscriber Agreement, Combined Evidence of Coverage and Disclosure Form contains the exact terms and conditions of coverage for the California Dental Network Family Dental HMO.

CALIFORNIA HEALTH BENEFIT EXCHANGE SHOP PROGRAM MODEL SUPPLEMENT RIDER TO GROUP SUBSCRIBER AGREEMENT
Group Subscriber Agreement • October 29th, 2019 • California

This California Health Benefit Exchange Small Business Health Options (SHOP) Program Supplement Rider (the “Supplement”) supplements that certain Group Subscriber Agreement (the “Agreement”) between Health Plan or Insurance Issuer (HEALTH PLAN) and GROUP. This Supplement is an integral part of the Agreement, and is intended by the Parties hereto to be interpreted to be consistent therewith; any inconsistencies or conflicts in terms with the Agreement are to be resolved in favor of the terms in this Supplement.

GROUP SUBSCRIBER AGREEMENT
Group Subscriber Agreement • November 17th, 2020 • California

This CaliforniaChoice Program Supplement Rider (the “Supplement”) supplements that certain Group Subscriber Agreement (the “Agreement”) between Oscar Health Plan of California (“PLAN”) and GROUP. This Supplement is an integral part of the Agreement, and is intended by the Parties hereto to be interpreted to be consistent therewith; any inconsistencies in terms are to be resolved in favor of the terms in this Supplement.

An Exclusive Provider Organization (EPO) Plan
Group Subscriber Agreement • February 8th, 2018 • California
GROUP SUBSCRIBER AGREEMENT
Group Subscriber Agreement • July 20th, 2016

This policy does not include pediatric dental services as required under the Federal Patient Protection and Affordable Care Act. This coverage is available in the insurance market and can be purchased as a stand-alone product. Please contact your agent or the New Mexico Health Insurance Exchange (http://www.nmhix.com) if you wish to purchase pediatric dental coverage or a stand-alone dental insurance product.

GROUP SUBSCRIBER AGREEMENT
Group Subscriber Agreement • September 29th, 2017

This policy does not include pediatric dental services as required under the Federal Patient Protection and Affordable Care Act. This coverage is available in the insurance market and can be purchased as a stand-alone product. Please contact your agent or the New Mexico Health Insurance Exchange (http://www.nmhix.com) if you wish to purchase pediatric dental coverage or a stand-alone dental insurance product.

Group Subscriber Agreement Combined Evidence of Coverage And
Group Subscriber Agreement • August 3rd, 2022

This Group Subscriber Agreement, Combined Evidence of Coverage and Disclosure Form contains the exact terms and conditions of coverage for the California Dental Network Family Dental HMO.

GROUP SUBSCRIBER AGREEMENT
Group Subscriber Agreement • July 23rd, 2019 • California

This California Health Benefit Exchange Small Business Health Options (SHOP) Program Supplement Rider (the “Supplement”) supplements that certain Group Subscriber Agreement (the “Agreement”) between Health Plan or Insurance Issuer (HEALTH PLAN) and GROUP. This Supplement is an integral part of the Agreement, and is intended by the Parties hereto to be interpreted to be consistent therewith; any inconsistencies or conflicts in terms with the Agreement are to be resolved in favor of the terms in this Supplement.

GROUP SUBSCRIBER AGREEMENT
Group Subscriber Agreement • July 20th, 2016

This policy does not include pediatric dental services as required under the Federal Patient Protection and Affordable Care Act. This coverage is available in the insurance market and can be purchased as a stand-alone product. Please contact your agent or the New Mexico Health Insurance Exchange (http://www.nmhix.com) if you wish to purchase pediatric dental coverage or a stand-alone dental insurance product.

GROUP SUBSCRIBER AGREEMENT
Group Subscriber Agreement • December 2nd, 2019 • California

whether the particular Member in question had previously selected, been assigned to or received Benefits from a particular Plan Provider. Plan shall refer members to the nearest hospital for Emergency Services or to available urgent care providers for treatment of Medically Necessary services and may provide reimbursement for such services. However, neither Plan nor any Plan Provider shall have any liability to Members for any delay in providing, or failure to provide Benefits under such conditions to the extent that Plan Providers are not available to provide Benefits.

GROUP SUBSCRIBER AGREEMENT AND GUIDE TO YOUR MANAGED CARE PLAN
Group Subscriber Agreement • February 12th, 2014
Group Subscriber Agreement Cover Page
Group Subscriber Agreement • March 31st, 2017 • California

THIS GROUP SUBSCRIBER AGREEMENT (“Group Agreement”) by and between WESTERN DENTAL SERVICES, INC. (“Plan”) and the employer, association, or other entity identified by “Group Name” on the Cover Page (“Group”) is effective on the date indicated on the Cover Page, and is made with reference to the following facts:

Presbyterian Health Plan, Inc.
Group Subscriber Agreement • June 25th, 2022
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