Common use of RIGHT TO EXAMINE AND CANCEL Clause in Contracts

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to HealthPartners, Inc. or an agent of HealthPartners, Inc., no later than the 10th day after you receive this Contract. Notices may be delivered or sent to HealthPartners, Attn.: Membership Accounting, ▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇, ▇.▇. ▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇. Notice of Cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the 10-day time period shown above. HealthPartners, Inc. will return all payments made for this Contract, including fees or Charges, within 10 days after receipt of Notice of Cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by a Member prior to Cancellation will be the Member’s responsibility. Membership Contract 2 Identification Card 2 Assignment of Benefits 3 Enrollment Payments 3 Benefits 3 Changes in Benefits 3 Amendments to This Contract 3 Conflict with Existing Law 3 How to Use the Network 4 Disclosure of Payments for Health Care Services 6 Step Therapy Override Process 6 Rights and Protections Under the No Surprises Act 6 Out-of-Network Provider Balance Billing Prohibition 7 Mental Health Parity and Addiction Equity Act 8 Prior Authorization of Services 8 Predetermination of Pediatric Dental Benefits 8 Access to Records and Confidentiality 9 Determination of Coverage 11 Complaints 11 Rights of Reimbursement and Subrogation 14 Coordination of Benefits 14 Medicare and This Contract 17 Effective Date 17 Eligibility 17 Changes in Coverage 18 Voluntary Termination 18 Involuntary Termination 18 Termination for Cause 19

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to HealthPartners, Inc. or an agent of HealthPartners, Inc., no later than the 10th tenth day after you receive this Contract. Notices may be delivered or sent to HealthPartners, . Attn.: Membership Accounting, ▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇, ▇.▇. ▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇. Notice of Cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the 10-ten day time period shown above. HealthPartners, Inc. will return all payments made for this Contract, including fees or Charges, within 10 ten days after receipt of Notice of Cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by a Member prior to Cancellation will be the Member’s responsibility. Membership Contract 2 Identification Card 2 Assignment of Benefits 3 Enrollment Payments 3 Benefits 3 Changes in Benefits 3 Amendments to This Contract 3 Conflict with Existing Law 3 How to Use the Network 4 3 Disclosure of Payments for Health Care Services 6 Step Therapy Override Process 6 Unauthorized Provider Services 6 Rights and Protections Under the No Surprises Act 6 Out-of-Network Provider Balance Billing Prohibition 7 Mental Health Parity and Addiction Equity Act 8 7 Prior Authorization of Services 8 Predetermination of Pediatric Dental Benefits 8 Access to Records and Confidentiality 9 8 Determination of Coverage 11 10 Complaints 11 10 Rights of Reimbursement and Subrogation 14 13 Coordination of Benefits 14 13 Medicare and This Contract 17 16 Effective Date 17 16 Eligibility 17 16 Changes in Coverage 18 17 Voluntary Termination 18 Involuntary Termination 18 Termination for Cause 1918 ABOUT HEALTHPARTNERS, INC., HEALTHPARTNERS INSURANCE COMPANY AND GROUP HEALTH PLAN, INC.‌ IMPORTANT ENROLLEE INFORMATION FOR NETWORK SERVICES:‌ • COVERED SERVICES. These are Network services provided by participating Network Providers or authorized by those Providers. This Contract fully defines what services are covered and describes procedures you must follow to obtain coverage. • PROVIDERS. Enrolling with us does not guarantee services by a particular Provider on the list of Network Providers. When a Provider is no longer part of the Network, you must choose among remaining Network Providers. • EMERGENCY SERVICES. Emergency services from Providers outside the Network will be covered if proper procedures are followed. Read this Contract for the procedures, benefits and limitations associated with Emergency Care from Network and Out-of-Network Providers. • EXCLUSIONS. Certain services or medical supplies are not covered. Read the Benefits Chart for a detailed explanation of exclusions. • CANCELLATION. Your coverage may be cancelled by you or us only under certain conditions. Read this Contract for the reasons for cancellation of coverage. • NEWBORN COVERAGE. If your health plan provides for dependents coverage, a newborn infant is covered from birth. We will not automatically know of the newborn’s birth or that you would like coverage under your plan. You should notify us of the newborn’s birth and that you would like coverage. If your Contract requires an additional enrollment payment for each dependent, we are entitled to all enrollment payments due from the time of the infant’s birth until the time you notify us of the birth. We may withhold payment of any health benefits for the newborn infant until any enrollment payments you owe are paid. • PRESCRIPTION DRUGS AND MEDICAL EQUIPMENT. Enrolling with us does not guarantee that any particular Prescription Drug will be available or that any particular piece of medical equipment will be available, even if the drug or equipment is available at the start of the Contract year. ENROLLEE BILL OF RIGHTS FOR NETWORK SERVICES‌ • Enrollees have the right to available and accessible services including emergency services 24 hours a day and seven days a week • Enrollees have the right to be informed of health problems, and to receive information regarding treatment alternatives and risks which is sufficient to assure informed choice • Enrollees have the right to refuse treatment, and the right to privacy of medical and financial records maintained by us and our Health Care Providers, in accordance with existing law • Enrollees have the right to file a complaint with us and the Commissioner of Health and the right to initiate a legal proceeding when experiencing a problem with us or our Health Care Providers • Enrollees have the right to a grace period of 31 days for each enrollment payment due, when falling due after the first enrollment payment, during which period this contract shall continue in force. If you are a recipient of the advance payment of the premium tax credit, you have a 3-month grace period, as described in the “Termination” section under subsection “Termination for Cause”. • Medicare Enrollees have the right to voluntarily disenroll from coverage and the right not to be requested or encouraged to disenroll, except in circumstances specified in federal law • Medicare Enrollees have the right to a clear description of nursing home and home care benefits covered by us

RIGHT TO EXAMINE AND CANCEL. You may cancel this Contract by delivering or mailing a written notice to HealthPartners, Inc. or an agent of HealthPartners, Inc., no later than the 10th tenth day after you receive this Contract. Notices may be delivered or sent to HealthPartners, . Attn.: Membership Accounting, ▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇, ▇.▇. ▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇. Notice of Cancellation given by mail and return of Contract given by mail are effective if they are properly addressed, postage prepaid and postmarked within the 10-ten day time period shown above. HealthPartners, Inc. will return all payments made for this Contract, including fees or Charges, within 10 ten days after receipt of Notice of Cancellation. This Contract will be considered void from the effective date of coverage, and you will be in the same position as if this Contract had never been issued to you. However, any claims incurred by a Member prior to Cancellation will be the Member’s responsibility. Membership Contract 2 Identification Card 2 Assignment of Benefits 3 Enrollment Payments 3 Benefits 3 Changes in Benefits 3 Amendments to This Contract 3 Conflict with Existing Law 3 How to Use the Network 4 3 Disclosure of Payments for Health Care Services 6 Step Therapy Override Process 6 Unauthorized Provider Services 6 Rights and Protections Under the No Surprises Act 6 Out-of-Network Provider Balance Billing Prohibition 7 Mental Health Parity and Addiction Equity Act 8 7 Prior Authorization of Services 8 Predetermination of Pediatric Dental Benefits 8 Access to Records and Confidentiality 9 8 Determination of Coverage 11 10 Complaints 11 10 Rights of Reimbursement and Subrogation 14 13 Coordination of Benefits 14 13 Medicare and This Contract 17 16 Effective Date 17 16 Eligibility 17 16 Changes in Coverage 18 17 Voluntary Termination 18 17 Involuntary Termination 18 17 Termination for Cause 1918 ABOUT HEALTHPARTNERS, INC., HEALTHPARTNERS INSURANCE COMPANY AND GROUP HEALTH PLAN, INC.‌ IMPORTANT ENROLLEE INFORMATION FOR NETWORK SERVICES:‌ • COVERED SERVICES. These are Network services provided by participating Network Providers or authorized by those Providers. This Contract fully defines what services are covered and describes procedures you must follow to obtain coverage. • PROVIDERS. Enrolling with us does not guarantee services by a particular Provider on the list of Network Providers. When a Provider is no longer part of the Network, you must choose among remaining Network Providers. • EMERGENCY SERVICES. Emergency services from Providers outside the Network will be covered if proper procedures are followed. Read this Contract for the procedures, benefits and limitations associated with Emergency Care from Network and Out-of-Network Providers. • EXCLUSIONS. Certain services or medical or dental supplies are not covered. Read the Benefits Chart for a detailed explanation of exclusions. • CANCELLATION. Your coverage may be cancelled by you or us only under certain conditions. Read this Contract for the reasons for cancellation of coverage. • NEWBORN COVERAGE. If your health plan provides for dependents coverage, a newborn infant is covered from birth. We will not automatically know of the newborn’s birth or that you would like coverage under your plan. You should notify us of the newborn’s birth and that you would like coverage. If your Contract requires an additional enrollment payment for each dependent, we are entitled to all enrollment payments due from the time of the infant’s birth until the time you notify us of the birth. We may withhold payment of any health benefits for the newborn infant until any enrollment payments you owe are paid. • PRESCRIPTION DRUGS AND MEDICAL EQUIPMENT. Enrolling with us does not guarantee that any particular Prescription Drug will be available or that any particular piece of medical equipment will be available, even if the drug or equipment is available at the start of the Contract year. ENROLLEE BILL OF RIGHTS FOR NETWORK SERVICES‌ • Enrollees have the right to available and accessible services including emergency services 24 hours a day and seven days a week • Enrollees have the right to be informed of health problems, and to receive information regarding treatment alternatives and risks which is sufficient to assure informed choice • Enrollees have the right to refuse treatment, and the right to privacy of medical or dental and financial records maintained by us and our Health Care Providers, in accordance with existing law • Enrollees have the right to file a complaint with us and the Commissioner of Health and the right to initiate a legal proceeding when experiencing a problem with us or our Health Care Providers • Enrollees have the right to a grace period of 31 days for each enrollment payment due, when falling due after the first enrollment payment, during which period this contract shall continue in force. If you are a recipient of the advance payment of the premium tax credit, you have a 3-month grace period, as described in the “Termination” section under subsection “Termination for Cause”. • Medicare Enrollees have the right to voluntarily disenroll from coverage and the right not to be requested or encouraged to disenroll, except in circumstances specified in federal law • Medicare Enrollees have the right to a clear description of nursing home and home care benefits covered by us