Common use of NOTICES AND OTHER INFORMATION Clause in Contracts

NOTICES AND OTHER INFORMATION. Any notices, documents, or other information under the Contract may be sent by United States Mail, postage prepaid, addressed as follows: If to Us: To Our last address on record with the Contractholder. If to the Contractholder: To the last address provided by the Contractholder on an enrollment or change of address form actually delivered to Us. If to a [Member]: To the last address provided by the [Member] on an enrollment or change of address form actually delivered to Us. OFFSET We reserve the right, before paying benefits to You, to use the amount of payment due to offset any claims payment previously made to You in error. OTHER RIGHTS We are only required to provide benefits to the extent stated in this Contract, its riders and attachments. We have no other liability. Services and supplies are to be provided in the most cost-effective manner practicable as Determined by Us. We reserve the right to use Our subsidiaries or appropriate employees or companies in administering this Contract. We reserve the right to modify or replace an erroneously issued Contract. Information in Your application may not be used by Us to void this Contract or in any legal action unless the application or a duplicate of it is attached to this Contract or has been furnished to You for attachment to this Contract. PAYMENT OF PREMIUMS - GRACE PERIOD The following paragraph only applies to [Members] who are NOT recipients of the premium tax credit and [Members] who are recipients of the premium tax credit but have not paid at least one full month’s premium during the calendar year Premiums are to be paid by You to Us. They are due on each premium due date. You may pay each premium other than the first within 31 days of the premium due date. Those days are known as the grace period. You are liable to pay premiums to Us from the first day the Contract is in force in order for this Contract to be considered in force on a premium paying basis. You will be liable for the payment of the premium for the time the Contract stays in effect. If any premium is not paid by the end of the grace period, [this Contract will continue in force without premium payment during the grace period and this Contract will end when the grace period ends.][coverage will end as of the end of the period for which premium has been paid. You may be responsible for the payment of charges incurred for services or supplies received during the grace period.] The following paragraph only applies to [Members] who ARE recipients of the premium tax credit who have paid at least one full month’s premium during the calendar year Premiums are to be paid by You to Us. They are due on each premium due date. While each premium is due by the premium due date there is a grace period for each premium other than the first that runs for 3 consecutive months from the premium due date. We will pay all appropriate claims for services and supplies received during the first month of the grace period. We will pend the payment of claims for services beyond the first month through the end of the 3 month grace period. We will send You a notice if You do not make payment by the premium due date and if payment is not made, the Contract will end 30 days following the date of the notice. You will be liable for the payment of the premium for the time coverage stays in effect. We will notify the Federal Department of Health and Human Services that You have not paid the required premium by the premium due date. We will also notify the Providers for the pended claims that the claims may be denied.

NOTICES AND OTHER INFORMATION. Any notices, documents, or other information under the Contract may be sent by United States Mail, postage prepaid, addressed as follows: If to Us: To Our last address on record with the Contractholder. If to the Contractholder: To the last address provided by the Contractholder on an enrollment or change of address form actually delivered to Us. If to a [Member]: To the last address provided by the [Member] on an enrollment or change of address form actually delivered to Us. OFFSET We reserve the right, before paying benefits to You, to use the amount of payment due to offset any claims payment previously made to You in error. OTHER RIGHTS We are only required to provide benefits to the extent stated in this Contract, its riders and attachments. We have no other liability. Services and supplies are to be provided in the most cost-effective manner practicable as Determined by Us. We reserve the right to use Our subsidiaries or appropriate employees or companies in administering this Contract. We reserve the right to modify or replace an erroneously issued Contract. Information in Your application may not be used by Us to void this Contract or in any legal action unless the application or a duplicate of it is attached to this Contract or has been furnished to You for attachment to this Contract. PAYMENT OF PREMIUMS - GRACE PERIOD The following paragraph only applies to [Members] who are NOT recipients of the premium tax credit and [Members] who are recipients of the premium tax credit but have not paid at least one full month’s premium during the calendar year Premiums are to be paid by You to Us. They are due on each premium due date. You may pay each premium Premium other than the first within 31 days of the premium due date. Those days are known as the grace period. You are liable to pay premiums Premiums to Us from the first day the Contract is in force in order for this Contract to be considered in force on a premium paying basis. You will be liable for the payment of the premium for the time the Contract stays in effect. If any premium is not paid by the end of the grace period, [this Contract will continue in force without premium payment during the grace period and this Contract will end when the grace period ends.][coverage will end as of the end of the period for which premium has been paid. You may be responsible for the payment of charges incurred for services or supplies received during the grace period.] The following paragraph only applies to [Members] who ARE recipients of the premium tax credit who have paid at least one full month’s premium during the calendar year Premiums are to be paid by You to Us. They are due on each premium due date. While each premium is due by the premium due date there is a grace period for each premium other than the first that runs for 3 consecutive months from the premium due date. We will pay all appropriate claims for services and supplies received during the first month of the grace period. We will pend the payment of claims for services beyond the first month through the end of the 3 month grace period. We will send You a notice if You do not make payment by the premium due date and if payment is not made, the Contract will end 30 days following the date of the notice. You will be liable for the payment of the premium for the time coverage stays in effect. We will notify the Federal Department of Health and Human Services that You have not paid the required premium by the premium due date. We will also notify the Providers for the pended claims that the claims may be denied.]

NOTICES AND OTHER INFORMATION. Any notices, documents, or other information under the Contract may be sent by United States Mail, postage prepaid, addressed as follows: If to Us: To Our last address on record with the Contractholder. If to the Contractholder: To the last address provided by the Contractholder on an enrollment or change of address form actually delivered to Us. If to a [Member]: To the last address provided by the [Member] on an enrollment or change of address form actually delivered to Us. OFFSET We reserve the right, before paying benefits to You, to use the amount of payment due to offset any claims payment previously made to You in error. OTHER RIGHTS We are only required to provide benefits to the extent stated in this Contract, its riders and attachments. We have no other liability. Services and supplies are to be provided in the most cost-effective manner practicable as Determined by Us. We reserve the right to use Our subsidiaries or appropriate employees or companies in administering this Contract. We reserve the right to modify or replace an erroneously issued Contract. Information in Your application may not be used by Us to void this Contract or in any legal action unless the application or a duplicate of it is attached to this Contract or has been furnished to You for attachment to this Contract. PAYMENT OF PREMIUMS - GRACE PERIOD The following paragraph only applies to [Members] who are NOT recipients of the premium tax credit and [Members] who are recipients of the premium tax credit but have not paid at least one full month’s premium during the calendar year Premiums are to be paid by You to Us. They are due on each premium due date. You may pay each Each premium other than the first must be paid within 31 days of the premium due date. Those days are known as the grace period. You are liable to pay premiums to Us Premiums must be paid from the first day the Contract is in force in order for this Contract to be considered in force on a premium paying basis. You will Premiums must be liable for the payment of the premium paid for the time the Contract stays in effect. If any premium is not paid by the end of the grace period, [this Contract will continue in force without premium payment during the grace period and this Contract will end when the grace period ends.][coverage will end as of the end of the period for which premium has been paid. You may be responsible for the payment of charges incurred for services or supplies received during the grace period.] The following paragraph only applies to [Members] who ARE recipients of the premium tax credit who have paid at least one full month’s premium during the calendar year Premiums are to be paid by You to Us. They are due on each premium due date. While each premium is due by the premium due date there is a grace period for each premium other than the first that runs for 3 consecutive months from the premium due date. We will pay all appropriate claims for services and supplies received during the first month of the grace period. We will pend the payment of claims for services beyond the first month through the end of the 3 month grace period. We will send You a notice if You do payment is not make payment made by the premium due date and if payment is not made, the Contract will end 30 days following the date of the notice. You will Premium must be liable for the payment of the premium paid for the time coverage stays in effect. We will notify the Federal Department of Health and Human Services that You have not paid if the required premium is not paid by the premium due date. We will also notify the Providers for the pended claims that the claims may be denied.

NOTICES AND OTHER INFORMATION. Any notices, documents, or other information under the Contract may be sent by United States Mail, postage prepaid, addressed as follows: If to Us: To Our last address on record with the Contractholder. If to the Contractholder: To the last address provided by the Contractholder on an enrollment or change of address form actually delivered to Us. If to a [Member]: To the last address provided by the [Member] on an enrollment or change of address form actually delivered to Us. OFFSET We reserve the right, before paying benefits to You, to use the amount of payment due to offset any claims payment previously made to You in error. OTHER RIGHTS We are only required to provide benefits to the extent stated in this Contract, its riders and attachments. We have no other liability. Services and supplies are to be provided in the most cost-effective manner practicable as Determined by Us. We reserve the right to use Our subsidiaries or appropriate employees or companies in administering this Contract. We reserve the right to modify or replace an erroneously issued Contract. Information in Your a Contractholder's application may not be used by Us to void this Contract or in any legal action unless the application or a duplicate of it is attached to this Contract or has been furnished to You the Contractholder for attachment to this Contract. PAYMENT OF PREMIUMS - GRACE PERIOD The following paragraph only applies Information in a [Member's] application may not be used by Us to void his or her coverage under this Contract or in any legal action unless the application or a duplicate of it is attached to the Evidence of Coverage issued to a [MembersMember], or has been mailed to a [Member] who are NOT recipients for attachment to his or her Evidence of Coverage. PARTICIPATION REQUIREMENTS At least [75%] of the premium tax credit and [Members] who are recipients of Employees eligible for insurance must be enrolled for coverage. If an eligible Employee is not covered by this Contract because: the premium tax credit but have not paid at least one full month’s premium during the calendar year Premiums are to be paid by You to Us. They are due on each premium due date. You may pay each premium Employee is covered as a Dependent under a spouse's coverage, other than individual coverage; the first within 31 days of the premium due date. Those days are known as the grace period. You are liable to pay premiums to Us from the first day the Contract Employee is in force in order for this Contract to be considered in force on a premium paying basis. You will be liable for the payment of the premium for the time the Contract stays in effect. If covered under any premium is not paid fully-insured Health Benefits Plan [issued by the end of the grace period, [this Contract will continue in force without premium payment during the grace period and this Contract will end when the grace period ends.][coverage will end as of the end of the period for which premium has been paid. You may be responsible for the payment of charges incurred for services or supplies received during the grace period.same carrier] The following paragraph only applies to [Members] who ARE recipients of the premium tax credit who have paid at least one full month’s premium during the calendar year Premiums are to be paid by You to Us. They are due on each premium due date. While each premium is due offered by the premium due date there Contractholder; the Employee is a grace period for each premium other than covered under Medicare; the first that runs for 3 consecutive months from Employee is covered under Medicaid or NJ FamilyCare; the premium due date. We will pay all appropriate claims for services and supplies received during the first month of the grace period. We will pend the payment of claims for services beyond the first month through the end of the 3 month grace period. We will send You a notice if You do not make payment by the premium due date and if payment Employee is not made, the Contract will end 30 days following the date of the notice. You will be liable for the payment of the premium for the time coverage stays in effect. We will notify the Federal Department of Health and Human Services that You have not paid the required premium by the premium due date. We will also notify the Providers for the pended claims that the claims may be denied.covered under Tricare; or

NOTICES AND OTHER INFORMATION. Any notices, documents, or other information under the Contract may be sent by United States Mail, postage prepaid, addressed as follows: If to Us: To Our last address on record with the Contractholder. If to the Contractholder: To the last address provided by the Contractholder on an enrollment or change of address form actually delivered to Us. If to a [Member]: To the last address provided by the [Member] on an enrollment or change of address form actually delivered to Us. OFFSET We reserve the right, before paying benefits to You, to use the amount of payment due to offset any claims payment previously made to You in error. OTHER RIGHTS We are only required to provide benefits to the extent stated in this Contract, its riders and attachments. We have no other liability. Services and supplies are to be provided in the most cost-effective manner practicable as Determined by Us. We reserve the right to use Our subsidiaries or appropriate employees or companies in administering this Contract. We reserve the right to modify or replace an erroneously issued Contract. Information in Your application may not be used by Us to void this Contract or in any legal action unless the application or a duplicate of it is attached to this Contract or has been furnished to You for attachment to this Contract. PAYMENT OF PREMIUMS - GRACE PERIOD The following paragraph only applies to [Members] who are NOT recipients of the premium tax credit and [Members] who are recipients of the premium tax credit but have not paid at least one full month’s premium during the calendar year Premiums are to be paid by You to Us. They are due on each premium due date. You may pay each premium other than the first within 31 days of the premium due date. Those days are known as the grace period. You are liable to pay premiums to Us from the first day the Contract is in force in order for this Contract to be considered in force on a premium paying basis. You will be liable for the payment of the premium for the time the Contract stays in effect. If any premium is not paid by the end of the grace period, [this Contract will continue in force without premium payment during the grace period and this Contract will end when the grace period ends.][coverage will end as of the end of the period for which premium has been paid. You may be responsible for the payment of charges incurred for services or supplies received during the grace period.] The following paragraph only applies to [Members] who ARE recipients of the premium tax credit who have paid at least one full month’s premium during the calendar year Premiums are to be paid by You to Us. They are due on each premium due date. While each premium is due by the premium due date there is a grace period for each premium other than the first that runs for 3 consecutive months from the premium due date. We will pay all appropriate claims for services and supplies received during the first month 31 days of the grace period. We will pend the payment of claims for services beyond the first month 31 days through the end of the 3 month grace period. We will send You a notice if You do not make payment by the premium due date and if payment is not made, the Contract will end 30 days following the date of the notice. You will be liable for the payment of the premium for the time coverage stays in effect. We will notify the Federal Department of Health and Human Services that You have not paid the required premium by the premium due date. We will also notify the Providers for the pended claims that the claims may be denied.

NOTICES AND OTHER INFORMATION. Any notices, documents, or other information under the Contract may be sent by United States Mail, postage prepaid, addressed as follows: If to Us: To Our last address on record with the Contractholder. If to the Contractholder: To the last address provided by the Contractholder on an enrollment or change of address form actually delivered to Us. If to a [Member]: To the last address provided by the [Member] on an enrollment or change of address form actually delivered to Us. OFFSET We reserve the right, before paying benefits to You, to use the amount of payment due to offset any claims payment previously made to You in error. OTHER RIGHTS We are only required to provide benefits to the extent stated in this Contract, its riders and attachments. We have no other liability. Services and supplies are to be provided in the most cost-effective manner practicable as Determined by Us. We reserve the right to use Our subsidiaries or appropriate employees or companies in administering this Contract. We reserve the right to modify or replace an erroneously issued Contract. Information in Your a Contractholder's application may not be used by Us to void this Contract or in any legal action unless the application or a duplicate of it is attached to this Contract or has been furnished to You the Contractholder for attachment to this Contract. PAYMENT OF PREMIUMS - GRACE PERIOD The following paragraph only applies Information in a [Member's] application may not be used by Us to void his or her coverage under this Contract or in any legal action unless the application or a duplicate of it is attached to the Evidence of Coverage issued to a [MembersMember], or has been mailed to a [Member] who are NOT recipients for attachment to his or her Evidence of Coverage. PARTICIPATION REQUIREMENTS At least [75%] of the premium tax credit and [Members] who are recipients of Employees eligible for insurance must be enrolled for coverage. If an Employee eligible for insurance is not covered by this Contract because: the premium tax credit but have not paid at least one full month’s premium during the calendar year Premiums are to be paid by You to Us. They are due on each premium due date. You may pay each premium Employee is covered as a Dependent under a spouse's coverage, other than individual coverage; the first within 31 days of the premium due date. Those days are known as the grace period. You are liable to pay premiums to Us from the first day the Contract Employee is in force in order for this Contract to be considered in force on a premium paying basis. You will be liable for the payment of the premium for the time the Contract stays in effect. If covered under any premium is not paid fully-insured Health Benefits Plan [issued by the end of the grace period, [this Contract will continue in force without premium payment during the grace period and this Contract will end when the grace period ends.][coverage will end as of the end of the period for which premium has been paid. You may be responsible for the payment of charges incurred for services or supplies received during the grace period.same carrier] The following paragraph only applies to [Members] who ARE recipients of the premium tax credit who have paid at least one full month’s premium during the calendar year Premiums are to be paid by You to Us. They are due on each premium due date. While each premium is due offered by the premium due date there Contractholder; the Employee is a grace period for each premium other than covered under Medicare; the first that runs for 3 consecutive months from Employee is covered under Medicaid or NJ FamilyCare; the premium due date. We will pay all appropriate claims for services and supplies received during the first month of the grace period. We will pend the payment of claims for services beyond the first month through the end of the 3 month grace period. We will send You a notice if You do not make payment by the premium due date and if payment Employee is not made, the Contract will end 30 days following the date of the notice. You will be liable for the payment of the premium for the time coverage stays in effect. We will notify the Federal Department of Health and Human Services that You have not paid the required premium by the premium due date. We will also notify the Providers for the pended claims that the claims may be denied.covered under Tricare; or