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This booklet is designed as a reference guide to help you understand your Benefits through VHP (the Plan) and how to use them. It is called a Combined Evidence of Coverage and Disclosure Form (EOC). It contains guidelines on how to get the most from your VHP Benefits, you should read it carefully as certain limitations and conditions affect your Benefit Plan. The following is a brief outline of the major sections included in this booklet. This outline together with the Table of Contents and the Index will help you better understand where you can go to find the information you need. Multi-Language General Information

These pages provide a brief overview about VHP health plan in English, Spanish, and Vietnamese.

Eligibility and Enrollment

This section outlines the eligibility requirements, walks you through the enrollment process, explains the Open Enrollment Period, and provides information relating to your Effective Date of Coverage.

Choice of Physicians & Providers – Access to Care

This section provides information on some of the choices you will need to make, including which Plan Providers you will be using and how to select your Primary Care Physician (PCP). You will also learn about your identification card, how to change your PCP, what happens when you need to see your doctor, and how to obtain a referral to a specialist for care.

Emergency & Urgently Needed Services

This section will help you understand the difference between Emergency and Urgently Needed Services. You will also identify who to call if your condition is urgent but not a medical emergency, what to do in the case of an emergency situation, as well as what to do should you need follow-up care after receiving Emergency or Urgently Needed Services.

Benefits Description Table

The Benefits Description Table or schedule of benefits explains the specifics of your Benefit Plan, including information on how to obtain Coverage and any Copayment that you may be charged for Covered Services. It outlines the benefits, services, limitations, and exclusions of your Benefit Plan.

Benefit Descriptions

For a more comprehensive explanation of the Covered Services contained in the “Benefits Description Table” refer to this “Benefits Descriptions” section. In this section, you will find detailed information on such things as what happens when you need to be hospitalized, the difference between health education and health promotion services, and how to get a prescription filled.

Limitations & Exclusions

This section lists the benefits and services not covered under the Agreement as well as certain limitations and exclusions that were not included in the “Benefits Description Table.” Many of the services listed in this section pertain to more than one benefit.

Payment & Reimbursement Responsibility

In this section find information about your premium, other Member charges and what happens when you reach your Copayment Maximum. The section also explains how VHP pays its Plan Providers and the procedure for sending VHP any Covered Services billings you may have received or how to file a Member Claim should you have to pay the bill or furnish a deposit for covered expenses due to an Emergency or Urgently Needed Service. In addition, you can find out your responsibilities when there is a Coordination of Benefits or third party reimbursement.