Your Right to Privacy

Personal information of any kind, such as information regarding your medical care or health status, is protected by Anthem Blue Cross' confidentially policies and procedures. While we require such information to process your claims, we do not liberate information that identifies you, as well as your diagnosis or medical condition without your consent.

Grievances

Each and every complaints and disputes relating to your coverage must be determined in accordance with Blue Cross' grievance procedure. Grievances may be made by the telephone or in writing to the phone number or address positioned on the back of your Blue Cross Identification Card. All grievances received by Blue Cross that cannot be resolved by phone to the mutual satisfaction of the Member and Blue Cross will be recognized in writing, together with a description of how Blue Cross offers to determine the grievance. We will not react in writing following a regular telephone inquiry unless and until it is specifically requested to do the same by the Member. Grievances that cannot be resolved by these procedures shall be resolved as indicated under Arbitration.

Department of Corporations

The California Department of Corporations is in charge for regulating health care services plans. The department's Health Plan Division has a toll-free telephone number (1-800-400-0815) for receiving complaints concerning health plans. Both hearing and speech impaired may use the California Relay Service's toll-free telephone numbers (1-800-735-2929 (TTY) or 1-888-877-5378 (TTY)) to make contact with the department. The department's Internet web site (http://www.CORP.CA.GOV) has complaint forms along with instructions online.

You should telephone us and use our grievance process before contacting the Health Plan Division if you have a grievance against us. Also if you need help with a grievance linking an emergency, a grievance that has not been satisfactorily resolved by your plan, or a grievance that has remained unresolved for more than 30 days, you may call the Health Plan Division for assistance. The plan's grievance process and the Health Plan Division's complaint review process are in addition to any other dispute resolution procedures that may be accessible to you, and your failure to use these processes does not preclude your use of any other remedy provided by law.

Binding Arbitration

Any dispute between the employer or covered persons and Blue Cross must be resolved by binding arbitration, if the amount in dispute goes above the jurisdictional limit of the Small Claims Court. Under this coverage, both you and Anthyem Blue Cross are giving up the right to take part in class arbitration or have any dispute decided in the court of law before a jury.

Medicare

Medicare is the primary coverage for groups of less than 20 employees under TEFRA/DEFRA. Blue Cross is considered primary coverage for groups of less than 20 employees. Blue Cross is considered primary coverage for groups of 20 or more employees. This Blue Cross coverage is NOT only a supplement to Medicare, but also provides benefits according to Non-Duplication of Medicare Claims.

This means that when Medicare is the primary health coverage, benefits will be provided in accordance with the benefits of the plan less any amount paid by Medicare. If the affiliate is Medicare eligible, even if the member did not sign up or claim Medicare benefits, the Blue Cross plan would pay only in accordance with the benefits of the plan less any amount that would have been payable by Medicare. If Medicare is the member's primary coverage, it is momentous that the member enrolls in both Medicare Parts A and B.

NOTE: Medicare-eligible employees enrolled in plans where Medicare is primary may attain an Individual Blue Cross of California Medicare Supplement with preexisting circumstances waved.

Coordination of Benefits

The advantages of a member's plan may get condensed if the member has some other group health, dental, drug or vision coverage, so that benefits and services the member receives from all group coverage's do not go beyond 100 percent of the Covered Expense.

Third Party Liability

If a member is injured, the party in charge may be legally obligated to reimburse for medical expenses associated to that injury. If the member recovers damages from a legally liable third party Blue Cross may recuperate benefits paid for medical expenses. Examples of third party liability include car accidents and work-related injuries.

Voiding Coverage for False and Misleading Information

False or missing information or failure to present any requisite enrollment material may form the basis for voiding coverage from the date a plan was issued or retroactively adjusting premium to what it would have been had the precise information been equipped. Benefits will not be paid for any claim submitted if coverage is void. Premiums already paid for the time period for which coverage was rescinded will be refunded, minus claims paid.

Loss Ratio

As required by law, we are recommending you that Blue Cross of California's incurred loss ratio for 1998 was 79.4 percent. This particular loss ratio was intended after all the provider discounts were applied.

Enrollment Guidelines