Part 2 – Explanation of Terms (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 16 For purposes of filing a claim or the formal appeal and grievance review (see Parts 9 and 10 of this Subscriber Certificate), Blue Cross Blue Shield HMO Blue considers “emergency medical care” to constitute “urgent care” as defined under the Employee Retirement Income Security Act of 1974, as amended (ERISA). Grievance A grievance is a type of oral or written complaint you make about care or service you received from Blue Cross Blue Shield HMO Blue or from a provider who participates in your health care network. This type of complaint concerns the service you receive or the quality of your care. It does not involve a dispute with a coverage or payment decision. Part 10 explains what you have to do to file a grievance. It also explains the review process. Group When you are enrolled in this health plan as a group member, the group is your agent and is not the agent of Blue Cross Blue Shield HMO Blue. The term “group” refers to the corporation, partnership, individual proprietorship, or other organization that has an agreement for Blue Cross Blue Shield HMO Blue to provide its enrolled group members with access to health care services and benefits. Group Contract When you enroll in this health plan as a group member, you are enrolled under a group contract. If this applies to your coverage in this health plan, your group eligibility, termination, and continuation of coverage provisions are described in Part 11 of this Subscriber Certificate. Under a group contract, the subscriber’s group has an agreement with Blue Cross Blue Shield HMO Blue to provide the subscriber and their enrolled dependents with access to health care services and benefits. The group will make payments to Blue Cross Blue Shield HMO Blue for coverage in this health plan for its enrolled group members. The group should also deliver to its group members all notices from Blue Cross Blue Shield HMO Blue. The group is the subscriber’s agent and is not the agent of Blue Cross Blue Shield HMO Blue. A group contract includes: this Subscriber Certificate; the Schedule of Benefits for your plan option; any riders or other changes to the group contract; the subscriber’s enrollment form; and the agreement that Blue Cross Blue Shield HMO Blue has with the subscriber’s group to provide coverage for the subscriber and their enrolled dependents. This Subscriber Certificate is not a contract between you and Blue Cross Blue Shield HMO Blue. The group contract will be governed by and construed according to the laws of the Commonwealth of Massachusetts, except as preempted by federal law. You hereby expressly acknowledge your understanding that the group contract constitutes a contract solely between your group on your behalf 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 your group on your behalf has not entered into the group 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 or your group on your behalf for any of Blue Cross Blue Shield HMO Blue’s obligations to you created under the group 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 group contract.