Part 2 – Explanation of Terms (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 21 In these cases, you are an outpatient even if you spend the night at the hospital or health care facility. You are also an outpatient if you are getting covered services at a health center, at a provider’s office (this can be either in-person or via telehealth), or in other covered outpatient settings, or at home. You are also an outpatient if you are getting covered services from a Blue Cross Blue Shield HMO Blue designated telehealth vendor. 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. Plan Sponsor When you are enrolled in this health plan as a group member, the plan sponsor is usually your employer and is the same as the plan sponsor designated under the Employee Retirement Income Security Act of 1974, as amended (ERISA). If you are a group member and you are not sure who your plan sponsor is, you should ask the subscriber’s employer. Plan Year When your plan option includes a deductible and/or an out-of-pocket maximum, these amounts will be calculated based on a calendar year or a plan year basis. The Schedule of Benefits for your plan option will show whether a calendar year or a plan year calculation applies to your coverage. (Also refer to riders—if there are any—that apply to your coverage in this health plan.) If a plan year calculation applies, it means the period of time that starts on the original effective date of your coverage in this health plan (or if you are enrolled in this health plan as a group member, your group’s coverage under the group contract) and continues for 12 consecutive months or until your renewal date, whichever comes first. A new plan year begins each 12-month period thereafter. If you do not know when your plan year begins, you can ask Blue Cross Blue Shield HMO Blue. Or, if you are enrolled in this health plan as a group member, you can ask your plan sponsor. Premium For coverage in this health plan, the subscriber (or the subscriber’s group on your behalf when you are enrolled in this health plan as a group member) will pay a monthly premium to Blue Cross Blue Shield HMO Blue. The total amount of your monthly premium is provided to you in the yearly evidence of coverage packet that is issued by Blue Cross Blue Shield HMO Blue. Blue Cross Blue Shield HMO Blue will provide you with access to health care services and benefits as long as the total premium that is owed for your coverage in this health plan is paid to Blue Cross Blue Shield HMO Blue. Blue Cross Blue Shield HMO Blue may change your premium. Each time Blue Cross Blue Shield HMO Blue changes the premium for coverage in this health plan, Blue Cross Blue Shield HMO Blue will notify you (or the subscriber’s group when you are enrolled in this health plan as a group member) before the change takes place. (If you enrolled in this health plan through the Massachusetts Health Connector, see Part 11 or Part 12, whichever applies to you, for information.)