 Misconduct. Examples of such termination include, but are not limited to the following: • Fraud, intentional misrepresentation or withholding of information the Subscriber knew or should have known was material or necessary to accurately determine eligibility or the correct premium • Abusive or threatening conduct repeatedly directed to an HCA employee, a health plan, or other HCA contracted vendor providing PEBB insurance coverage on behalf of HCA, its employees, or other persons The PEBB Program will enroll an employee and their eligible Dependents in another PEBB medical plan upon termination from this plan. Appeal Rights Any current or former employee of a State Agency or their Dependent may appeal a decision made by the State Agency regarding PEBB eligibility, enrollment, or premium surcharges to the State Agency. Any current or former employee of an employer group, such as a county, city, port, water district, etc., that contracts with HCA for PEBB benefits, or their Dependent may appeal a decision made by an employer group regarding PEBB eligibility, enrollment, or premium surcharges to the employer group. Any Enrollee may appeal a decision made by the PEBB Program regarding PEBB eligibility, enrollment, premium payments, or premium surcharges to the PEBB Appeals Unit. Any Enrollee may appeal a decision regarding the administration of a PEBB medical plan by following the appeal provisions of the Plan, except when regarding eligibility, enrollment, and premium payment decisions. Learn more at hca.wa.gov/pebb-appeals. Relationship to Law and Regulations Any provision of this Evidence of Coverage that is in conflict with any governing law or regulation of Washington State is hereby amended to comply with the minimum requirements of such law or regulation. HOW TO OBTAIN SERVICES The provider network for this High Deductible Health Plan is the Classic network. The Classic network includes Participating Providers who are either employed by us or contract directly or indirectly with us to provide covered Services for Members enrolled in this High Deductible Health Plan. You pay the Cost Share amount shown on your “Benefit Summary” when you receive covered Services from Participating Providers and Participating Facilities. To receive covered benefits, you must obtain Services from Participating Providers and Participating Facilities except as described under the following sections in this EOC:  “Referrals to Non-Participating Providers and Non-Participating Facilities.”  “Emergency, Post-Stabilization, and Urgent Care.”  “Receiving Care in Another Kaiser Foundation Health Plan Service Area.”  “Out-of-Area Coverage for Dependents.”  “Ambulance Services.” To locate a Participating Provider or Participating Facility, contact Member Services or visit kp.org/doctors to see all Kaiser Permanente locations near you, search for Participating Providers, and read online provider profiles. We will not directly or indirectly prohibit you from freely contracting at any time to obtain health care Services from Non-Participating Providers and Non-Participating Facilities outside the Plan. However, if you EWCLGHDHP1983ACT0124 30 WAPEBB-CD-ACT