Common use of Written Correspondence Clause in Contracts

Written Correspondence. You may write to us about any question or concern at the following address: Presbyterian Insurance Company, Inc. Attention: Presbyterian Customer Service Center X.X. Xxx 00000 Xxxxxxxxxxx, XX 00000-0000 Member Rights and Responsibilities‌ This Section explains your rights and responsibilities under this Agreement and how you can participate on our Consumer Advisory Board. As a Member of Presbyterian Insurance Company, Inc. (PIC), you have specific rights and certain responsibilities. In accordance with New Mexico Administrative Code, we implement written policies and procedures regarding the rights and responsibilities of Covered Persons and implementation of such rights and responsibilities. Your rights and responsibilities are important and are explained in this Section and on our website at xxxxx://xxx.xxx.xxx/Pages/member-rights.aspx. Member Rights The Group Subscriber Agreement (GSA) shall include a complete statement that a Member shall have the right to: • Available and accessible services when medically necessary, 24 hours per day, seven days per week for Urgent or Emergency Healthcare Services, and for other Healthcare Services as defined by the GSA; • A right to be treated with respect and recognition of their dignity and their right to privacy; • Be provided with information concerning our policies and procedures regarding products, services, Providers, Appeals procedures and other information about Presbyterian Insurance Company, Inc., and the benefits provided; • To choose a Primary Care Practitioner within the limits of the Covered Benefits, plan network, and as provided by this rule, including the right to refuse care of specific Healthcare Professionals; • Receive from the Covered Person’s Physician(s) or Provider, in terms that the Covered Person understands, an explanation of his or her complete medical condition, recommended treatment, risk(s) of the treatment, expected results and reasonable medical alternatives, irrespective of our position on treatment options; if the Covered Person is not capable of understanding the information, the explanation shall be provided to his or her next of kin, guardian, agent or surrogate, if available, and documented in the Covered Person’s medical record; • All the rights afforded by law, rule, or regulation as a patient in a licensed Healthcare Facility, including the right to refuse medication and treatment after possible consequences of this decision have been explained in language the Covered Person understands; • Prompt notification, as required in this rule, of termination or changes in benefits, services or Provider network; • File a Complaint or Appeal with us or the Superintendent and to receive an answer to those Complaints in accordance with existing law; • Privacy of medical and financial records maintained by us and our Healthcare Providers, in accordance with existing law; • Know upon request of any financial arrangements or provisions between Presbyterian Insurance Company, Inc. and our Providers which may restrict referral or treatment options or limit the services offered to Covered Persons; • Adequate access to qualified Health Professionals for the treatment of Covered Benefits near where the Covered Person lives or works within our Service Area; • To the extent available and applicable to us, to affordable healthcare, with limits on Out- of-pocket expenses, including the right to seek care from a non-participating (Out-of- network) Provider, and an explanation of a Covered Person’s financial responsibility when services are provided by a non-participating (Out-of-network) Provider, or provided without required Prior Authorization; • An approved example of the financial responsibility incurred by a Covered Person when going Out-of-network; inclusion of the entire “billing examples” provided by the Superintendent available on the Division’s website at the time of the filing of the plan will be deemed satisfaction of this requirement; any substitution for, or changes to, the Division’s “billing examples” requires written approval by the Superintendent, in our Healthcare Benefit Plan that provides benefits for Out-of-network Coverage; • Detailed information about Coverage, Maximum Benefits, and Exclusions of specific conditions, ailments or disorders, including restricted Prescription benefits, and all requirements that a Covered Person must follow for Prior Authorization and Utilization Review; • A complete explanation of why care is denied, an opportunity to Appeal the decision to our internal review, the right to a secondary Appeal, and the right to request the Superintendent’s assistance.

Written Correspondence. You may write to us about any question or concern at the following address: Presbyterian Insurance Company, Inc. Attention: Presbyterian Customer Service Center X.X. Xxx 00000 Xxxxxxxxxxx, XX 00000-0000 Member Rights and Responsibilities‌ Responsibilities This Section explains your rights and responsibilities under this Agreement and how you can participate on our Consumer Advisory Board. As a Member of Presbyterian Insurance Company, Inc. (PIC), ) you have specific rights and certain responsibilities. In accordance with New Mexico Administrative Code, we implement written policies and procedures regarding the rights and responsibilities of Covered Persons and implementation of such rights and responsibilities. Your rights and responsibilities are important and are explained in this Section and on our website at xxxxx://xxx.xxx.xxx/Pages/member-rights.aspx. Member Rights The Group Subscriber Agreement (GSA) shall include a complete statement that a Member shall have the right to: • Available and accessible services when medically necessary, 24 hours hour per day, seven 7 days per week for Urgent or Emergency Healthcare Health Care Services, and for other Healthcare Health Care Services as defined by the GSA; • A right to be treated with respect and recognition of their dignity and their right to privacy; • Be provided with information concerning our policies and procedures regarding products, services, Providers, Appeals procedures and other information about Presbyterian Insurance Company, Inc., and the benefits provided; • To choose a Primary Care Practitioner within the limits of the Covered Benefits, plan network, and as provided by this rule, including the right to refuse care of specific Healthcare Health Care Professionals; • Receive from the Covered Person’s Physician(s) or Provider, in terms that the Covered Person understands, an explanation of his or her complete medical condition, recommended treatment, risk(s) of the treatment, expected results and reasonable medical alternatives, irrespective of our position on treatment options; if the Covered Person is not capable of understanding the information, the explanation shall be provided to his or her next of kin, guardian, agent or surrogate, if available, and documented in the Covered Person’s medical record; • All the rights afforded by law, rule, or regulation as a patient in a licensed Healthcare Health Care Facility, including the right to refuse medication and treatment after possible consequences of this decision have been explained in language the Covered Person understands; • Prompt notification, as required in this rule, of termination or changes in benefits, services or Provider network; • File a Complaint or Appeal with us or the Superintendent and to receive an answer to those Complaints in accordance with existing law; • Privacy of medical and financial records maintained by us and our Healthcare Health Care Providers, in accordance with existing law; • Know upon request of any financial arrangements or provisions between Presbyterian Insurance Company, Inc. and our Providers which may restrict referral or treatment options or limit the services offered to Covered Persons; • Adequate access to qualified Health Professionals for the treatment of Covered Benefits near where the Covered Person lives or works within our Service Area; • To the extent available and applicable to us, to affordable healthcarehealth care, with limits on Out- of-pocket expenses, including the right to seek care from a non-participating (Out-of- network) Provider, and an explanation of a Covered Person’s financial responsibility when services are provided by a non-participating (Out-of-network) Provider, or provided without required Prior Authorization; • An approved example of the financial responsibility incurred by a Covered Person when going Out-of-network; inclusion of the entire “billing examples” provided by the Superintendent available on the Division’s website at the time of the filing of the plan will be deemed satisfaction of this requirement; any substitution for, or changes to, the Division’s “billing examples” requires written approval by the Superintendent, in our Healthcare Health Care Benefit Plan that provides benefits for Out-of-network Coverage; • Detailed information about Coverage, Maximum Benefits, and Exclusions of specific conditions, ailments or disorders, including restricted Prescription benefits, and all requirements that a Covered Person must follow for Prior Authorization and Utilization Review; • A complete explanation of why care is denied, an opportunity to Appeal the decision to our internal review, the right to a secondary Appeal, and the right to request the Superintendent’s assistance.

Written Correspondence. You may write to us about any question or concern at the following address: Presbyterian Insurance Company, Inc. Attention: Presbyterian Customer Service Center X.X. Xxx 00000 XxxxxxxxxxxP.O. Box 26267 Albuquerque, XX 00000NM 87125-0000 6267 Member Rights and Responsibilities‌ This Section explains your rights and responsibilities under this Agreement and how you can participate on our Consumer Advisory Board. As a Member of Presbyterian Insurance Company, Inc. (PIC), you have specific rights and certain responsibilities. In accordance with New Mexico Administrative Code, we implement written policies and procedures regarding the rights and responsibilities of Covered Persons and implementation of such rights and responsibilities. Your rights and responsibilities are important and are explained in this Section and on our website at xxxxx://xxx.xxx.xxx/Pages/member-rights.aspx. Member Rights The Group Subscriber Agreement (GSA) shall include a complete statement that a Member shall have the right to: • Available and accessible services when medically necessary, 24 hours per day, seven 7 days per week for Urgent or Emergency Healthcare Services, and for other Healthcare Services as defined by the GSA; • A right to be treated with respect and recognition of their dignity and their right to privacy; • Be provided with information concerning our policies and procedures regarding products, services, Providers, Appeals procedures and other information about Presbyterian Insurance Company, Inc., and the benefits provided; • To choose a Primary Care Practitioner within the limits of the Covered Benefits, plan network, and as provided by this rule, including the right to refuse care of specific Healthcare Professionals; • Receive from the Covered Person’s Physician(s) or Provider, in terms that the Covered Person understands, an explanation of his or her complete medical condition, recommended treatment, risk(s) of the treatment, expected results and reasonable medical alternatives, irrespective of our position on treatment options; if the Covered Person is not capable of understanding the information, the explanation shall be provided to his or her next of kin, guardian, agent or surrogate, if available, and documented in the Covered Person’s medical record; • All the rights afforded by law, rule, or regulation as a patient in a licensed Healthcare Facility, including the right to refuse medication and treatment after possible consequences of this decision have been explained in language the Covered Person understands; • Prompt notification, as required in this rule, of termination or changes in benefits, services or Provider network; • File a Complaint or Appeal with us or the Superintendent and to receive an answer to those Complaints in accordance with existing law; • Privacy of medical and financial records maintained by us and our Healthcare Providers, in accordance with existing law; • Know upon request of any financial arrangements or provisions between Presbyterian Insurance Company, Inc. and our Providers which may restrict referral or treatment options or limit the services offered to Covered Persons; • Adequate access to qualified Health Professionals for the treatment of Covered Benefits near where the Covered Person lives or works within our Service Area; • To the extent available and applicable to us, to affordable healthcare, with limits on Out- of-pocket expenses, including the right to seek care from a non-participating (Out-of- network) Provider, and an explanation of a Covered Person’s financial responsibility when services are provided by a non-participating (Out-of-network) Provider, or provided without required Prior Authorization; • An approved example of the financial responsibility incurred by a Covered Person when going Out-of-network; inclusion of the entire “billing examples” provided by the Superintendent available on the Division’s website at the time of the filing of the plan will be deemed satisfaction of this requirement; any substitution for, or changes to, the Division’s “billing examples” requires written approval by the Superintendent, in our Healthcare Benefit Plan that provides benefits for Out-of-network Coverage; • Detailed information about Coverage, Maximum Benefits, and Exclusions of specific conditions, ailments or disorders, including restricted Prescription benefits, and all requirements that a Covered Person must follow for Prior Authorization and Utilization Review; • A complete explanation of why care is denied, an opportunity to Appeal the decision to our internal review, the right to a secondary Appeal, and the right to request the Superintendent’s assistance.

Written Correspondence. You may write to us about any question or concern at the following address: Presbyterian Insurance Company, Inc. Attention: Presbyterian Customer Service Center X.X. Xxx 00000 XxxxxxxxxxxP.O. Box 26267 Albuquerque, XX 00000NM 87125-0000 6267 Member Rights and Responsibilities‌ This Section explains your rights and responsibilities under this Agreement and how you can participate on our Consumer Advisory Board. As a Member of Presbyterian Insurance Company, Inc. (PIC), you have specific rights and certain responsibilities. In accordance with New Mexico Administrative Code, we implement written policies and procedures regarding the rights and responsibilities of Covered Persons and implementation of such rights and responsibilities. Your rights and responsibilities are important and are explained in this Section and on our website at xxxxx://xxx.xxx.xxx/Pages/member-rights.aspx. Member Rights The Group Subscriber Agreement (GSA) shall include a complete statement that a Member shall have the right to: • Available and accessible services when medically necessary, 24 hours per day, seven days per week for Urgent or Emergency Healthcare Services, and for other Healthcare Services as defined by the GSA; • A right to be treated with respect and recognition of their dignity and their right to privacy; • Be provided with information concerning our policies and procedures regarding products, services, Providers, Appeals procedures and other information about Presbyterian Insurance Company, Inc., and the benefits provided; • To choose a Primary Care Practitioner within the limits of the Covered Benefits, plan network, and as provided by this rule, including the right to refuse care of specific Healthcare Professionals; • Receive from the Covered Person’s Physician(s) or Provider, in terms that the Covered Person understands, an explanation of his or her complete medical condition, recommended treatment, risk(s) of the treatment, expected results and reasonable medical alternatives, irrespective of our position on treatment options; if the Covered Person is not capable of understanding the information, the explanation shall be provided to his or her next of kin, guardian, agent or surrogate, if available, and documented in the Covered Person’s medical record; • All the rights afforded by law, rule, or regulation as a patient in a licensed Healthcare Facility, including the right to refuse medication and treatment after possible consequences of this decision have been explained in language the Covered Person understands; • Prompt notification, as required in this rule, of termination or changes in benefits, services or Provider network; • File a Complaint or Appeal with us or the Superintendent and to receive an answer to those Complaints in accordance with existing law; • Privacy of medical and financial records maintained by us and our Healthcare Providers, in accordance with existing law; • Know upon request of any financial arrangements or provisions between Presbyterian Insurance Company, Inc. and our Providers which may restrict referral or treatment options or limit the services offered to Covered Persons; • Adequate access to qualified Health Professionals for the treatment of Covered Benefits near where the Covered Person lives or works within our Service Area; • To the extent available and applicable to us, to affordable healthcare, with limits on Out- of-pocket expenses, including the right to seek care from a non-participating (Out-of- network) Provider, and an explanation of a Covered Person’s financial responsibility when services are provided by a non-participating (Out-of-network) Provider, or provided without required Prior Authorization; • An approved example of the financial responsibility incurred by a Covered Person when going Out-of-network; inclusion of the entire “billing examples” provided by the Superintendent available on the Division’s website at the time of the filing of the plan will be deemed satisfaction of this requirement; any substitution for, or changes to, the Division’s “billing examples” requires written approval by the Superintendent, in our Healthcare Benefit Plan that provides benefits for Out-of-network Coverage; • Detailed information about Coverage, Maximum Benefits, and Exclusions of specific conditions, ailments or disorders, including restricted Prescription benefits, and all requirements that a Covered Person must follow for Prior Authorization and Utilization Review; • A complete explanation of why care is denied, an opportunity to Appeal the decision to our internal review, the right to a secondary Appeal, and the right to request the Superintendent’s assistance.