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Attachment A Proposed change to Standard 2013 Experience-Rated HMO Health Benefits Contract NOTE: New and revised language is underlined and language to be deleted is struck out. 1. Section 1.9 Plan

The carrier shall provide a copy of the revised plan as required in §6410.15 to a member within 30 days following a decision by the carrier to modify or terminate a revised plan. If the carrier makes no change in the revised plan, the member's claim shall be considered in compliance with the contract, and if the carrier makes a change, the plan shall not take effect until the revised plan is approved and approved by, and signed by, the member. However, if the carrier agrees to modify or terminate a revised plan, the carrier may not take effect before the revised plan will be approved and approved by the member. 2. Applicability of Standard. The requirement does not apply to any noncontracted HMO. (8) Responsiveness to Requests for Reconsideration for Excessive Rate HMO: REQUIREMENT: The carrier shall ensure that each HMO plan is compliant with the requirements in paragraphs 1 through 8. The carrier shall be responsible for monitoring and assessing adherence by HMO's to the requirements. (9) Reconsideration of HMO Plans; Notification of Member. When a HMO plan is changed, the carrier must provide a notice to the member containing the following information in a prominent location in the member's HMO package: (i) the current HMO plan; (ii) the effective date of the change; (iii) the reasons for the change; (iv) the effective date for renewing the HMO plan; and (v) an opportunity for a member to withdraw or amend the notice. As soon as practicable after receiving a request for reconsideration or an amendment of the HMO plan by a HMO member, the carrier can submit the requested change to the appropriate governing body. The governing body shall approve or deny the change and notify the member of its decision as soon as practicable. When an HMO changes a member's plan, the HMO shall provide the member notice of the action on or before the date the member's HMO plan is to be changed in compliance with §6410.26. If the HMO does not modify the plan in a timely manner, the HMO will be considered out of compliance, the member's plan will be changed in compliance with the requirements of §6410.

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