SAFEGUARD HEALTH PLANS, INC. -1992

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ORGANIZATION shall send one check covening all Members to SAFi j AF D at the add ss indicated in Paragraph a a specified Paragraph f the Accepta e Agreement, and continuing g each r, oath thereafter on said date, for ft d urtion of this contra ct . ORGANUATION shall also send an eligibility list via hard copy, mag fletic tape or other electronic ' SAFEGUARD specifying the names and other identifying data for each Menib r to be co��ered for succeeding n�edrun� t �A� niontli. Said eligibility list shall list information exclusively for Safeguard and shall: a Pc cif calls identify those Members who are newly eligible to receive services. h) Specifically identify those Members who are no longer eligible to receive services. (c) Be provided to SAFEGUARD no late` than the twenty #f�if` day o the month prec di g a rn nth during which Members will be eligible for benefits. 3J* determination of who is eligible to participate and rbo is actually participating in the � shall be determined rAIIZA T`l and SAFEGUARD shall have the right to rely upon that detenrnaon. Any disputes or rnuis regarding eligibility, including g . r regarding hts renewal, reinstatement and the like, if any, shall referred by SAFEGUARD to �� ORGANIZATION, which shall then advise SAFEGUARD of its determination. (a ) DeDependents shall include the lawful spouse of the Subscriber, and all newborn infants whose coverage . ter the nio ent of birth. Legally adopted children and stepchildren shall b covered from and after the shall connence l~ro�n ar�d of date of placement. Subject to notification to SAFEGUARD by NI A' N and payment of the appropriate prepayment fee, if any, dependents shall be eligible for coverage on the day the Subscriber i for or coverage or on the day the Subscriber acquires such Dependent, whichever i later. under the ale specified Dependents shall also include all unmamied children fied in paragraph � e who are chiefly dependent on the Subscriber for support. Eligibility may be extended p to the age Acceptance Agreement l b of the Acceptance Agreement for unmarried children who are principally dependent upon the specified �� l'aap F ' Subscriber for maintenance an support re d su rt and are registered students in regular, full-time attendance at an accredited school, college g ` or university+ c) Coverage shall not terminate while a dependent child is and continues to be i) incapable of self - sustaining employment by reason of mental retardation or pbysical handicap; and H chiefly dependent upon the Subscriber for support and maintenance provided the Subscriber fumishes proof of such incapacity and dependency to SAFEGUARD within } ' `nin the limiting age set forth in paragraph b) above, and every two ( ) years thereafter, if thirty-one � 1) days of the child at �. requested by SAFEGUARD. AII�T`�1 fail to pay the monthly prepay�n�ent fee for any member when due, SAFEGUARD nay, . Should ORS p ' member from its list of eligible members. Should ORGANIZATION subsequently pay SAFEGUARD at its discretion delete said g all mounts dui, SAFEGUARD � reinstate any reinsta an y member deleted from said eligibility list. Should ORGANUATION fail to notify SAFEGUARD of a member wlio is do lon er eligible for benefits, pursuant to paragraph 3.4 above, SAFEGUARD shall continue to be enti tled to its m prepayment fee for such Members until such time as SAFEGUARD i notified in Ming of the onthl p re p ` t + n and the Subscriber and his or her Dependent(s) are removed from the eligibility list specified above. �ubs�ber s ter'n�rnatro , a Should SAFEGUARD be notified of a Subscriber's ternnination after the eligibility list is prodded by ORGANIZATION to SAFEGUARD, coverage for the Subseniber and his or her Dependent(s) shall continue until the end of the applicable monthly: period, if ably, and SAFEGUARD shall retain or must be paid the applicable prepayment fee to the end of the monthly period for the 4 Subscribes and his r her Dependent(s). ' it Dependents are ell ,lble to become Members o#` SAFEGUARD at the One designated by the 3.8 Subscribers and the g ORGANIZATION as of the effective date of this Contract. For the Subscribers of the ORGANIZATION wbo become eligible as + l ter the effective date of this Contract, the effective date of eligibility shall be subject to the determined b� the ORGANIZATION of eligibility rules of the ORGANIZATION. W. ADMIMSTRAT1 � A D is obligated to give any notice o Members with regard to any matters covered by this . i 4'henever SAFEGUARD g Care Service Plan Act of 1975, as amended, or any regulations issued pursuant thereto by the Contract, e Knox-Keene k�ealtll Car such notice to a representative o California ar►e�nt of Corporations, it shall sufficient for SQUID to gives ORGANIZATION sh" then b obligated to give that nonce to the Members in its next regular n shall such notice be given later than thirty fl days after SAFEGUARD gives such notice to conuacat�on. but in no event g h f` e R�rA�ATT . The ORGANIZATION representative designated to receive such notice is set forth in Paragrap Acceptance Agreement, 'ors of all mater-* a1s, such as a Combined Evidence of Coverage and Disclosure Form and . With regard to the distribution ` distributed pursuant to the Knox -Keene Health Care Service flan Act of 19'75, a amended, or any other material recurred to be d�trx p regulation issued pursuant the et r o it shad be sufficient for SAFEGUARD to deliver the material for distribution to the A'TI N designated in Paragraph A of the Acceptance Agreement. ORGANIZATION shall be representative of I� g - responsible to distribute such mterial to Subscribers and/or Eligible Participants. -