Common use of Notice to Subscribers and Members Clause in Contracts

Notice to Subscribers and Members. It is the responsibility of Contract Holder to notify the Members of the termination of the Group Agreement in compliance with all applicable laws. In the event we provide notice of cancellation for non-payment of premium to Contract Holder, Contract Holder agrees to promptly mail a legible, true copy of the notice of cancellation to all Subscribers at their current address. The notice of cancellation to Contract Holder will include: • the cause for cancellation, including reference to the applicable clause in the Group Agreement • a statement that the cause for cancellation was not due to the Member’s health status or requirements for health care services • that a Member who alleges that cancellation was due to the Member’s health status may request a review of cancellation by the Department of Managed Health Care • information regarding the Member’s COBRA, Cal-COBRA, conversion Coverage and HIPAA Individual coverage. Such notice must be mailed to Subscribers 15 days prior to the date of termination. If the Contract Holder fails to deliver the above-referenced notice of cancellation and deliver proof of mailing to Us, We will mail notice directly to the individual Subscribers: coverage will not end until the 15th day after HMO mails the notice. The Contract Holder is required to reimburse Us for the costs of such mailing and for all premiums accrued do to the non-performance of this contractual obligation. However, We reserve the right to notify Members of termination of the Group Agreement for any reason, including non-payment of Premium.

Notice to Subscribers and Members. It is the responsibility of Contract Holder to notify the Members of the termination of the Group Agreement in compliance with all applicable laws. In the event we provide notice of cancellation for non-payment of premium to Contract Holder, Contract Holder agrees to promptly mail a legible, true copy of the notice of cancellation to all Subscribers at their current address. The notice of cancellation to Contract Holder will include: • the cause for cancellation, including reference to the applicable clause in the Group Agreement • a statement that the cause for cancellation was not due to the Member’s health status or requirements for health care services • that a Member who alleges that cancellation was due to the Member’s health status may request a review of cancellation by the Department of Managed Health Care • information regarding the Member’s COBRA, Cal-COBRA, conversion Coverage and HIPAA Individual coverage. Such notice must be mailed to Subscribers 15 days prior to the date of termination. If the Contract Holder fails to deliver the above-referenced notice of cancellation and deliver proof of mailing to Us, We will mail notice directly to the individual Subscribers: coverage will not end until the 15th day after HMO mails the notice. The Contract Holder is required to reimburse Us for the costs of such mailing and for all premiums accrued do to the non-performance of this contractual obligation. However, We reserve the right to notify Members of termination of the Group Agreement for any reason, including non-payment of Premium. HMO CA AMEND-GA-TERM-1 04-04 1 This Evidence of Coverage (“EOC”) is part of the Group Agreement (“Group Agreement”) between Aetna Health of California Inc., hereinafter referred to as HMO, and the Contract Holder. The Group Agreement determines the terms and conditions of coverage. The EOC describes health care benefits. Provisions of this EOC include the Schedule of Benefits, any riders and any amendments, endorsements, inserts, or attachments. Amendments, riders or endorsements may be delivered with the EOC or added thereafter.