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HHRC-EOC 02.10.2017 12 Evidence of Coverage within fifteen (15) days of it being due; Member commits fraud or deception in using Plan’s services; Member obtains other group coverage. If the group benefit plan is terminated prior to the date that a Member’s Cal-COBRA continuation coverage would expire, Member’s coverage with Plan will expire. Member has the opportunity to continue coverage under any group benefit plan purchased by Group. If Group purchases a new plan, that plan will send Member premium information and enrollment forms. Member may continue coverage for the remainder of the Cal-COBRA continuation period. It is important for Member to keep Plan and Group updated if there are any changes of address. Cal-COBRA continuation coverage will terminate if Member fails to enroll and pay premiums to the new group benefit plan within thirty (30) days after receiving notification of the termination of Plan’s group benefit plan. If Group changes its EAP benefit to another plan, Member’s coverage with Plan will expire, and Member will be given the opportunity to continue coverage with the new plan. The new plan is required to provide coverage for the balance of the Cal-COBRA continuation coverage period. XV. COMPLAINT AND GRIEVANCE PROCEDURE A grievance is a written or oral expression of dissatisfaction regarding Plan and/or an EAP Provider, including quality of care concerns, and includes a complaint, dispute, request for reconsideration, or appeal made by you or your representative. A complaint is the same as a grievance. You are entitled to present complaints and grievances within one year of the occurrence. Plan is obliged to seek to resolve such complaints and grievances in a timely fashion. Plan has established a procedure for processing and resolving your complaints and grievances. Should you desire to register a complaint or grievance with Plan concerning Benefits, you can either call Plan at the toll-free telephone number 1-800-342-8111, or access Plan’s website at www.resourcesforliving.com to either download the complaint form or to fill it out online. To request a copy of Plan’s complaint form, write directly to Plan at 10260 Meanley Drive, San Diego, CA 92131. The telephone call or letter should be addressed to the Director, Clinical Quality Improvement. Plan will acknowledge each complaint and grievance within five (5) days of receipt. The Director, Clinical Quality Improvement will receive and investigate all Member complaints and grievances. The Director, Clinical Quality Improvement will respond to you stating the disposition and the rationale within thirty (30) days of receipt of the grievance. If the grievance is not resolved to your satisfaction, a second level of review may be requested within ten (10) days of notification of such disposition. Any such request will be reviewed by the Medical Director and responded to within seventy-two (72) hours of receipt. REV: 03-10-23 MI ATTY/AGR.2023.039/Aetna (EAP Services Agreement) (Page 36 of 42)