AMERICAN SPECIALTY HEALTH PLANS GROUP SUBSCRIBER AGMT 1998

Services rendered by the applicable provider, less Copayments, to Members under such provider's care at the time of termination until such services are completed, unless ASHP makes reasonable and medically appropriate provisions for the assumption of Covered Services by another Participating Chiropractor. 4. BENEFITS AND CONDITIONS FOR COVERAGE. 4.01 Benefits. Subject to all terms, conditions, exclusions, and limitations set forth in this Agreement, all eligible Members, upon receipt by ASHP of all applicable monthly Health Plan Premium payments, shall be entitled to Chiropractic Services described in this Agreement. 4.02 Member Obligations. Subscriber shall complete and submit to ASHP an enrollment application or other forms or statements as ASHP may reasonably request. Subscriber agrees to promptly notify ASHP or Group of any changes in the information contained in the ASHP Enrollment Kit. Subscriber warrants that to the best of his or her knowledge, all information contained in such application, forms and statements is true and complete, and agrees that all rights to benefits under this Agreement are subject to the condition that all such information is true and complete. 4.03 Pre-Authorization for Chiropractic Services. Except for the initial examination by a Participating Chiropractor and Emergency Services, all Chiropractic Services received by a Member must be pre-authorized by ASHP in order to be covered under this Health Plan. A Member's Participating Chiropractor shall be responsible for obtaining such pre-authorization from ASHP. Members shall cooperate with ASHP by providing information requested by ASHP in obtaining pre-authorization and by meeting with any ASHP personnel or contracting Chiropractor, if requested by ASHP. ASHP will evaluate the nature and severity of the Member's condition and determine the need for Chiropractic Services. ASHP will contact the Participating Chiropractor regarding those Chiropractic Services which are pre-authorized. ASHP will pre-authorize treatment for thirty (30) days to ninety (90) days. At the end of such period, a Member's Participating Chiropractor may request that additional Chiropractic Services bepre-authorized for Member. 4.04 Concurrent Review of Chiropractic Services. Member shall cooperate with ASHP in ASHP's concurrent review of Chiropractic Services which shall be conducted regularly throughout Member's chiropractic treatment. The purpose of concurrent reviews is to ensure that Chiropractic Services are effective and appropriate. 4.05 Copayments. Copayments, when applicable, must be paid by a Member at the time Chiropractic Services are rendered. Failure to pay a Copayment may result in termination of Member's coverage under this Health Plan. A schedule of the applicable Copayments for services rendered to Member is set forth in the Schedule of Benefits, incorporated herein and attached hereto as Attachment A. 4.06 Payment for Non-Covered Services. ASHP or the Participating Chiropractor may collect directly from the Member for non-covered services or for services rendered due to fraud or misrepresentation by Member. 4.07 Emergency Services. In the event of an emergency, before seeking Chiropractic Services, a Member should contact his or her primary care physician or medical group. ASHP shall only cover Emergency Services as defined herein. Emergency services may be provided without pre-authorization from ASHP. If ASHP decides that the professional services rendered to Member were not Emergency Services, ASHP shall have no responsibility to cover such services. Continuing or follow-up treatment after Emergency Services have been rendered must be pre-authorized and coordinated by ASHP. ASHP may elect to transfer Member to a Participating Chiropractor if such transfer would not create an unreasonable risk to Member's health.