A.

Claims Procedures

To claim payment or reimbursement of the cost of health care services received from non-Kaiser Permanente providers you must:

1.

Notify Kaiser Permanente within 48 hours after emergency hospital care is received.

2.

File a claim on forms provided by Kaiser Permanente. Kaiser Permanente must receive a completed claim form, including any bills the Covered Person has received, within 180 days after the first emergency service for which the Covered Person is requesting payment.

3.

Claims for emergency services provided by a non-Kaiser Permanente physician or hospital within the Service Area are subject to medical review. In order to be covered, all treatment must be obtained from a Kaiser Permanente Medical Office or from a designated hospital unless death, serious disability or significant jeopardy to the Covered Person's condition would result from any delay caused by obtaining treatment at a Kaiser Permanente facility.

Claims are acted upon within 60 days after they are received, unless additional information is required. If additional information is required, the Covered Person will be advised in writing of what is needed within the 60-day period, and Kaiser Permanente will specify the date by which a decision on the claim can be expected. The decision will be made no later than 60 days after additional material has been submitted, but in no event more than 180 days after the claim was first filed. At that time, the claim may be granted or completely or partially denied.

B.

Member Satisfaction Procedure

If a Covered Person is not satisfied with the services he/she receives at one of Kaiser Permanente's Medical Offices, or if a Covered Person has a concern about the personnel or some other matter relating to services and wishes to file a complaint, do so either:

By sending a written complaint to the Customer Service Department Kaiser Permanente Administrative Services at 2500 South Havana Street, Aurora, CO 80014; or

By coming to Customer Service Department at Kaiser Permanente Administrative Services; or

By telephoning the Customer Service Department at (303) 338-3800.

After a complaint is received, this is what happens:

1.

A Customer Service Representative reviews the complaint and makes a complete investigation verifying all the relevant facts.

2.

All parties involved with the complaint, including the complainant, are then interviewed.

3.

The Representative makes an evaluation and a recommendation for corrective action, if any.

4.

When a written complaint is filed, Kaiser Permanente will respond to the complainant in writing usually within 10 business days with the recommended action unless additional information is required.

5.

When a verbal complaint is filed, a verbal response is usually made to the complainant within 24 hours.

The complainant may appeal Kaiser Permanente's decision regarding the complaint within 60 days after notice of the decision is received. The complainant's appeal must be in writing and addressed to:

Kaiser Permanente

Supervisor of Customer Service Department

2500 South Havana Street

Aurora, CO 80014

The complainant's written appeal will be reviewed by the Customer Service Supervisor who will either respond in writing or refer the complaint for review and response by the Health Plan Review Committee. You will receive a written response from Kaiser Permanente within 60 days of receipt of your appeal.

Kaiser Permanente wants members to be satisfied with their services, facilities and Physicians. By using this Customer Satisfaction Procedure, it gives Kaiser Permanente the opportunity to correct any problems that keep them from meeting members' expectations and health care needs. If a member is dissatisfied for any reason, please let Kaiser Permanente know by calling or visiting the Customer Service Department at:

Kaiser Permanente Administrative Services

2500 South Havana Street

Aurora, CO 80014

(303) 338-3800 or (303) 338-3820 TDD

C.

Charge for Service or Purchase

The charge for service or purchase will be deemed to have been incurred on the date the service is performed or the date the purchase occurs.

D.

Workers' Compensation

This Coverage is not in lieu of Workers' Compensation insurance and does not satisfy any requirements for coverage by Workers' Compensation insurance.

E.

Binding Arbitration

By enrolling in Kaiser Permanente, you are agreeing to have any and all disputes and/or claims for money damages, including issues of medical malpractice, decided by neutral binding arbitration rather than a jury or court trial.

You have the right to seek legal counsel, and with respect to medical malpractice claims only, you have the right to rescind your agreement to arbitrate within ninety days from the date of signature, unless this agreement was signed in contemplation of hospitalization, in which case you have ninety days after discharge or release from the hospital to rescind your agreement to submit medical malpractice claims to binding arbitration.

No health care provider shall withhold the provision of emergency medical services to any person because of that person's failure or refusal to sign an agreement containing a provision for binding arbitration of any dispute arising as to professional negligence of the provider.

No health care provider shall refuse to provide medical care services to any patient solely because such patient refused to sign an agreement to arbitrate medical malpractice claims, or exercised the ninety--day right of rescission.

F.

Statements

In the absence of fraud, all statements made by the Covered Person and his or her Dependents will be deemed representations and not warranties. No such representations will void the Coverage or be used to deny a claim, unless a copy of the instrument containing such representation is or has been furnished to the Covered Person or to his or her beneficiary, if any.

G.

Relationships Between Parties

The relationship between a Kaiser Permanente Physician and any Covered Person is that of provider and patient. The Kaiser Permanente Physician is solely responsible for the medical services provided to any Covered Person. The Kaiser Permanente authorized hospitals are solely responsible for the hospital services provided to any Covered Person.

H.

Records

Each Covered Person must provide Kaiser Permanente a signed release authorizing any person or institution that has attended to, examined, or treated the Covered Person, to furnish Kaiser Permanente at any reasonable time, upon its request, any and all information and records or copies of records relating to attendance, examinations or treatment received by the Covered Person. Kaiser Permanente agrees that such information and records will be considered confidential.

Kaiser Permanente shall have the right to submit any and all records concerning episodes of health care for Covered Persons to appropriate medical or other review bodies, or to individuals and/or Physicians.

I.

Examination of Covered Persons

In the event of a question or dispute concerning the provision for Health Services or payment for such services under the Plan, Kaiser Permanente may require that a Covered Person be examined, at Kaiser Permanente's expense, by a Kaiser Permanente Physician.

J.

Conformity With Statutes

Any provision of the Plan which, on its Effective Date, is in conflict with the statutes of the jurisdiction in which it is delivered is hereby amended to conform to the minimum requirements of such statutes.

K.

Right to Modify, Amend or Terminate Plan

UCAR reserves the right to modify, amend or terminate the Plan by giving 60 days' written notice to Kaiser Permanente prior to UCAR's anniversary date.

L.

Return of Over Payment

Payment made for charges must be returned to the Plan if it is found that such charges were paid in error.

January 2004