2022

1 2022 Certificate of 10 Section 1 Title Page (Cover Page) Individual Policy This document includes important information that describes Your Policy. Your Policy is a legal contract between the Subscriber and Bright Health Insurance Company ( Bright HealthCare ). It explains the Benefits for health care services. Benefits are for Covered Persons and are subject to plan terms, conditions, exclusions, and limitations. This Policy is issued when We receive the application and in consideration of any and all required payment(s). Entire Contract This Policy includes Your: Enrollment application Schedule of BenefitsThe documents above make up the entire contract between Bright HealthCare and the Subscriber.

2 As of the effective date of the contract, this Policy supersedes all other agreements between the Subscriber and Bright HealthCare. Changes to the Policy must be given to You in writing. Changes to the Policy must be signed by the executive officer of Bright HealthCare and approval must be endorsed on or attached to this Policy. No agent has authority to change this Policy or to waive any of its provisions. How to Use this Document Read Your Policy and Amendments. We especially encourage You to review these sections: Schedule of Benefits What is Covered Limitations/ExclusionsMake sure You understand how Your Policy works. Many sections refer to other sections.

3 You may not find all the information You need in one section. Keep the Policy in a safe place so You can find and read it as needed. Defined Terms The Definitions section of this Policy will help You understand the content. When You see a word or term that begins with a capital letter, You will find it in the Definitions section. Please read the definition to find out what a word or term means. When You see the words "We," "Us," and "Our," We are referring to Bright HealthCare. When You see the words "You" and "Your," We are referring to Covered Persons. If the Covered Person is under age 18, You and Your refers to the Responsible Adult.

4 BRIGHT HEALTHCARE Simeon Schindelman Chief Executive Officer Plan Name: Bright HealthCare [Insert Plan Name from Corresponding SOB] Member Name: [ ] Coverage Effective Date: [ ] Premium Amount: [ ] BHCO0001-0521 11 Section 2 Contact Us On Our Website at: Please contact Us for more information. Questions About Your Benefits Customer Service: (855) 827-4448 TTY: 711 Send Claims or other written correspondence to Us at: Bright HealthCare Box 16275 Reading, PA 19612 Nondiscrimination Notice and Assistance with Communication Bright HealthCare does not exclude, Deny Benefits to, or otherwise discriminate against any individual on the basis of sex, age, race, color, national origin, or disability.

5 Bright HealthCare means Bright HealthCare and their affiliates, which are listed below. Language Assistance and Alternate Formats Assistance is available at no cost to help You communicate with Us. Services include, but are not limited to: interpreters for languages other than English Written information in alternative formats such as large print Assistance with reading Bright HealthCare websitesFor help with these services, please call the member services number on Your member ID card. If You think that We failed to provide language assistance or alternate formats, or You were discriminated against because of Your sex, age, race, color, national origin, or disability, You can send a complaint to: Bright HealthCare Civil Rights Coordinator Box 853943 Richardson, TX 75085-3943 Phone: (844) 202-2154 Email: You can also file a complaint with the Department of Health and Human Services, the Office of Civil Rights: Online: Complaint forms are available at Phone: Toll-free 1-800-368-1019, 1-800-537-7697 (TDD) Mail.

6 Department of Health and Human Services, 200 Independence Avenue SW,Room 509F, HHH Building, Washington 20201If You need help with Your complaint, please call the member services number on Your member ID card. You must send the complaint within 60 days of discovering the issue. BHCO0001-0521 12 Language Assistance and Alternate Formats This information is available in other formats like large print. To request another format, please call the member services number on your member ID card. BHCO0001-0521 13 BHCO0001-0521 14 Member Rights and Responsibilities You Have the Right to: Receive medical treatment that is available when You need it and is handled in a way that respects Your privacy and dignity.

7 Get understandable information You need about Your health Benefit plan, including information about services that are covered and not covered, and any costs that You will be responsible for paying. Obtain information about Our wellness programs and the qualifications of clinical staff who support the programs. Have access to a current list of Network Physicians, Hospitals, and places You can receive care, and information about a particular Physician s education, training, and practice. Select a Primary Care Physician for Yourself and each member of Your family who is enrolled, and to change Your Primary Care Physician for any reason.

8 Although it is highly recommended that You select a Primary Care Physician, it is not required under this plan in order to receive Benefits. We may assign a Primary Care Physician to You and notify You of the assignment. If Your choose to select a different Primary Care Provider, please notify Us. Have Your medical information kept confidential by Us and Your Physician. We honor the confidentiality of Covered Person information and adhere to all federal and state regulations regarding confidentiality and the protection of personal health information. Participate with Your health care professional in health care decisions and have Your health care professional give You information about Your medical condition and Your treatment options, regardless of coverage or cost.

9 You have the right to receive this information in terms and language You understand. Learn about any care You receive. You should be made aware of any special programs or services that We have made available to assist You, as well as how to enroll, or change programs or services. You should be asked for Your consent for all care unless there is an Emergency, and Your life and health are in serious danger. Refuse medical care and disenroll from programs/services offered by Us. If You refuse medical care, Your health care professional should tell You what might happen. We urge You to discuss Your concerns about care with Your Primary Care Physician or other participating health care professional.

10 Your Physician or health care professional will give You advice, but You will have the final decision. Be heard. Our complaint handling process is designed to: hear and act on Your complaint or concern about Us and/or the quality of care You receive from health care professionals and the various places You receive care in Our network; provide a courteous, prompt response; and guide You through Our appeal process if You do not agree with Our decision. Make recommendations regarding Our policies that affect Your rights and responsibilities. You Have the Responsibility to: Pay Your monthly Premium including any outstanding Premium due as a result of a retroactive changes to Your Policy on or before the due date.