Member Services Assistance

Once enrolled, your coverage may be canceled only for the Disenrollment and Termination of Benefits reasons identified below. To voluntarily disenroll, contact your employer and complete and sign the appropriate paper- work. Your employer will notify you of your effective date of termination. If you or your Dependent(s) coverage is terminated involuntarily, you will receive notice of the date of termination. Until the effective date of your Disenrollment or Termination, you will remain a VHP Member and are responsible to: • continue to receive all Covered Services from Plan Providers (except in the event of an

Emergency or Out of Network/Service Area Urgently Need Services); • pay for all applicable membership premiums; and • continue to adhere to all requirements of your VHP membership. Once your Disenrollment or Termination from the Benefit Plan becomes effective, your VHP Identification Card will no longer be valid. You may not be reinstated automatically if coverage is canceled or terminated. Fraudulent use of your VHP Identification Card, the services or facilities of VHP or its Plan Providers, and/or fraud or misrepresentation on the enrollment application form will result in an investigation and appropriate legal action. If you have additional questions about the Disenrollment or Termination process, please review the following sections and/or call your employer or a VHP Member Services Representative at 1.888.421.8444 (toll-free).

Cancellation of Group Service Agreement

Your employer may terminate your coverage upon written notice to VHP. If your employer terminates or does not renew the Group Service Agreement for any reason, or if VHP terminates the Agreement, your Coverage will cease on the date the Agreement terminates. You will not be able to convert to Individual Conversion unless you are disabled and eligible for continued coverage. Refer to “Continuation of Coverage for Totally Disabled Members.”

Loss of Eligibility

Recent health care reform requires VHP and its Groups to continue to offer Coverage to dependent children until the child turns 26 years of age (through age 25). Extended Coverage to Dependents will occur at the time of the Group’s renewal of their Agreement or as determined by the Group. For more information regarding the health care reform’s extension of Dependent Coverage, contact your employer or VHP Member Services at 1.888.421.8444 (toll-free). If you cease to meet VHP and/or your Group eligibility requirements, then your and your Dependent’s coverage will involuntarily terminate. (Subject to the provisions for continuation of coverage or conversion of benefits.) You and your employer must notify VHP immediately if you or your Dependent(s) cease to meet the eligibility requirements. Refer to the “Eligibility” section. You lose eligibility if: • you no longer work or reside within Santa Clara County and you have no intention of returning to the Santa Clara County for an uninterrupted period of more than 90 consecutive days.

• you are an Eligible Retiree and you reside outside the Service Area, adjacent or contiguous counties to the Service Area, or San Francisco County with no intention of returning for an uninterrupted period of more than 90 consecutive days. Adjacent counties include San Mateo,

Alameda, Stanislaus, Merced, San Benito, Monterey, and Santa Cruz Counties. Your legal spouse loses eligibility: • upon dissolution of the marriage, Coverage for a Subscriber’s spouse will automatically terminate. In addition, the enrollment of all of the spouse’s Dependent(s) who are not also Eligible

Dependents of the Subscriber will terminate. Coverage will terminate on the last day of the month/ pay period of the dissolution of marriage. • if he/she moves out of the service area, he/she is eligible for Emergency Services only. Your domestic partner (as defined by the Group Service Agreement or as in accordance with state and federal requirements) loses eligibility: • upon dissolution of the relationship as certified by your employer, Coverage for a Subscriber’s domestic partner will automatically terminate as defined by your Group. In addition, the enrollment of all of the domestic partner’s Dependent(s) who are not also Eligible Dependents of the

Subscriber will terminate. Coverage will terminate on the last day of the month/pay period of the dissolution of relationship as certified by your employer. • if he/she moves out of the service area, he/she is eligible for Emergency Services only. Your Eligible Dependent child(ren) lose eligibility and coverage automatically terminates when they: • reach age 26 (contact your employer regarding your Dependent’s extension of Coverage); or • become employed and they are eligible to enroll in an employer plan - applies to adult children aged 19 through age 25. • if he/she moves out of the Service Area, he/she is eligible for Emergency or Urgently Needed

Services only. For Eligible Dependent child(ren) who were incapable of self-sustaining employment by reason of mental disorder or physical handicap prior to age 26 and are chiefly dependent on you for support and maintenance, coverage will discontinue: • at age 26 if the child is no longer disabled; or • if the child is older than 26, the earlier of the date the child recovers from the handicap or the date the child is no longer chiefly dependent on you for support and maintenance. Your Dependent(s) may also lose eligibility in the event of your death. If the Subscriber dies, Dependent Member(s) must contact the Group for details on Disenrollment or continued Coverage for Members.

Loss of eligibility does not affect any rights to continue Group Coverage under COBRA, as described in the “Individual Continuation of Coverage” section.

Disenrollment by Member

If you or your Dependent(s) elect coverage under another health benefits plan offered by or through your employer, then your Coverage terminates automatically at the time and date the alternate coverage becomes effective. You and your employer agree to notify VHP immediately that you or

your Dependent(s) have elected coverage elsewhere. You or your Dependent(s) may voluntarily disenroll from VHP at any time and for any reason. You may disenroll by notifying VHP and/or your employer in writing of your intent to cancel your membership. Your Coverage terminates at midnight on the last day of the pay period/month in which you provide notice to VHP of your intent to disenroll or at midnight on the effective date as determined by your employer.

Cancellation of Members for Cause

VHP may terminate your membership and the membership of your Dependent(s) if: You or your Dependent(s) commit fraud or deception in connection with membership, Plan, or a Plan Provider, then Plan may terminate Member within 30 days notice. Some examples of fraud or deception include: • Intentional failure or with willful misrepresentation to furnish material information required in connection with the enrollment under the Agreement, such as knowingly misrepresenting eligibility or enrollment information, or intentionally giving us incorrect or incomplete material enrollment information in any document, or if you fail to intentionally notify us of material changes in your family status (e.g. dependent changes) or Medicare coverage that may affect eligibility for membership or Benefits. The Plan may terminate Member with 30 days notice. • Engage in deception in the use of the services or facilities of VHP, Plan Providers, or Non-Plan

Providers. • Unauthorized use of a Plan identification card by permitting a non-Member to use a Member identification card to obtain Benefits. Cancellation of a Dependent for cause will solely apply to the Dependent involved and will not affect the enrollment of the Subscriber or any other Dependent(s). You may use the Grievance procedure to contest an involuntary Disenrollment or Termination for cause. Refer to “Member Grievance” section.

Termination for Nonpayment

VHP may terminate your and/or your Dependent(s) membership if payment is not made in the amounts due within the time VHP specifies in writing, subject to compliance with a 30 day grace period notice requirement. If you receive notice that your coverage is being canceled or not renewed due to failure to pay your premium, VHP must provide you with a 30-day “grace period.” The grace period begins after the last day of paid coverage. VHP must continue to provide coverage during the grace period, through you will be financially responsible for the premium for the coverage provided during the grace period. The grace period must last at least 30 days after the date of the last day of paid coverage. During the grace period, you can avoid cancellation or nonrenewal by paying the premium you owe to VHP. If you do not pay the premium by the end of the grace period, your coverage will be terminated at the end of the grace period. You will still be legally responsible for any unpaid premium you owe to the Plan. If you wish to terminate your coverage immediately, contact VHP as soon as possible. After the effective date of Termination, you and your Dependent(s) may reinstate membership only by paying all amounts due, completing a new application, and re-enrolling in accordance with all VHP requirements.