Recitals 2 Article 1 General Provisions 4 a 1 Purpose 4 b 2 Applicable Law and Regulation 4

z)3.4 Participating Providers

3.4.1 Provider Contracts

b) Contractor shall include in each Provider Agreement a requirement that Participating Providers comply with all other applicable laws, rules and regulations.

c) Contractor shall use commercially reasonable efforts to require the provisions of subsection (d) to be included in each: (i) Provider Agreement entered into by and between Contractor and a Participating Provider, and (ii) any subcontracting arrangement entered into by a Participating Provider.

d) Provision of Covered Services. Contractor shall undertake commercially reasonable efforts to ensure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider complies with the applicable terms and conditions set forth in this Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include the following:

i. Coordination with the Exchange and other programs and stakeholders;

ii. Relationship of the parties as independent contractors (Section 1.3(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.3(b));

iii. Participating Provider directory requirements (Section 3.4.4);

iv. Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.3.5);

v. Notices, network requirements and other obligations relating to costs of out-of-network services and other benefits (Section 3.4.3);

vi. Provider credentialing, including, maintenance of licensure and insurance (Section 3.4.2);

vii. Customer service standards (Section 3.6);

viii. Utilization review and appeal processes (Section 4.3);

ix. Maintenance of a corporate compliance program (Section 1.2);

x. Enrollment and eligibility determinations and collection practices (Article 2);

xi. Appeals and grievances (Section 3.6.2);

xii. Enrollee and marketing materials (Section 2.5);

xiii. Disclosure of information required by the Exchange, including, financial and clinical (Section 1.13; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10));

xiv. Nondiscrimination (Section 1.11);

xv. Conflict of interest and integrity (Section 1.12);

xvi. Other laws (Section 1.14);

xvii. Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required pursuant to Attachment 7;

xviii. Performance Measures, to the extent applicable to Participating Providers (Article 6);

xix. Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees (Section 3.35 and Article 7);

xx. Security and privacy requirements, including compliance with HIPAA (Article 9); and

xxi. Maintenance of books and records (Article 10).

3.4.2 Provider Credentialing

3.4.3 Enrollee costs; Disclosure

To the extent that Contractor’s QHPs either (i) provide coverage for out-of-network services and/or (ii) impose additional fees for such services, Contractor shall disclose to the Enrollee, at the enrollee’s request, the amount Contractor will pay for covered proposed non-emergency out-of-network services.

Contractor shall require its Participating Providers to inform every Enrollee in a manner that allows the Enrollee the opportunity to act upon a Participating Provider’s proposal or recommendation regarding (i) the use of a non-network provider or facility or (ii) the referral of an Enrollee to a non-network provider or facility for proposed non-emergency Covered Services. Contractor shall require Participating Providers to disclose to an Enrollee considering accessing non-emergency services from a network provider if a non-network provider or facility will be used as part of the network provider’s plan of care. The Contractor’s obligation for this provision can be met through routine updates to their provider manual. Participating Providers may rely on Contractor’s provider directory in fulfilling their obligation under this provision.

3.4.4 Provider Directory

The network and directory information provided to the Exchange shall take into consideration the ethnic and language diversity of providers available to serve Enrollees of the Exchange.