Part 2 – Explanation of Terms (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 17 Individual Contract When you enroll in this health plan directly as an individual, you are enrolled for coverage under an individual contract. (This means that you did not enroll for coverage in this health plan as a group member.) If this applies to your coverage in this health plan, your eligibility and termination provisions are described in Part 12 of this Subscriber Certificate. Under an individual contract, the subscriber has an agreement directly with Blue Cross Blue Shield HMO Blue to provide the subscriber and their enrolled dependents with access to health care services and benefits. The subscriber will make payments to Blue Cross Blue Shield HMO Blue for coverage in this health plan. Blue Cross Blue Shield HMO Blue will send notices to the subscriber. An individual contract includes: this Subscriber Certificate; the Schedule of Benefits for your plan option; any riders or other changes to the individual contract; and the subscriber’s enrollment form. The individual contract will be governed by and construed according to the laws of the Commonwealth of Massachusetts, except as preempted by federal law. Important Note: If you enroll in this health plan as an individual member through the Massachusetts Health Connector, the subscriber has an agreement with the Health Connector. The subscriber will usually make payments to the Health Connector for coverage in this health plan. The Health Connector will send all notices to the subscriber. You hereby expressly acknowledge your understanding that an individual contract constitutes a contract solely between you and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. (Blue Cross Blue Shield HMO Blue), which is a corporation independent of and operating under a license from the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans (the “Association”), permitting Blue Cross Blue Shield HMO Blue to use the Blue Cross and Blue Shield Service Marks in the Commonwealth of Massachusetts, and that Blue Cross Blue Shield HMO Blue is not contracting as the agent of the Association. You further acknowledge and agree that you have not entered into an individual contract based upon representations by any person other than Blue Cross Blue Shield HMO Blue and that no person, entity, or organization other than Blue Cross Blue Shield HMO Blue will be held accountable or liable to you for any of Blue Cross Blue Shield HMO Blue’s obligations to you created under an individual contract. This paragraph will not create any additional obligations whatsoever on the part of Blue Cross Blue Shield HMO Blue other than those obligations created under other provisions of the individual contract. Inpatient The term “inpatient” refers to your status as a hospital patient, or as a patient in a health care facility, when you are admitted as a registered bed patient. Even if you stay in the hospital or health care facility overnight, you might still be considered an “outpatient.” Your status is important because it affects how much you will pay for covered services, like x-rays, drugs, lab tests, and physician services. You are an inpatient starting the day you are formally admitted with a doctor’s order as a registered bed patient in a hospital or other health care facility. Note: You are an outpatient when you are kept in a hospital or health care facility solely for observation, even though you use a bed or spend the night. Observation services are to help the doctor decide if a patient needs to be admitted for care or can be discharged. These services may be given in the emergency room or another area of the hospital. If you would normally pay a copayment for outpatient emergency medical care or outpatient medical care services, the copayment will be waived when you are held for observation. But, you must still pay your deductible and/or coinsurance, whichever applies.