Notice and consent for electronic delivery

Thank you for applying for a Regence health insurance policy! You are receiving this Notice and Consent for Electronic Delivery ("Notice") because you indicated your preferred method of communication is email on the application and/or provided your email address on the application. Before we can communicate with you electronically about your application, we need your consent. Please review the below information carefully prior to giving your consent and keep this Notice for your records.

The types of electronic communications you may receive from us about your application include, but are not limited to:

• requests related to proof of residency, evidence of a special enrollment period, verification of demographic information, power of attorney documents, court orders or other enrollment and eligibility status information;
• requests for a new application, or completion or confirmation of any information on the application for health coverage;
• notification of the status of your application, including final determinations for coverage.

If you elected to work with an agent or broker and the agent or broker's name is on the application, electronic communications that are sent to you about your application will also be sent to your agent or broker.

If you consent to receive electronic communications regarding your application, you agree and understand that:

• The same terms and conditions shall apply with respect to electronic communications as for those delivered in paper form.
• Regence will communicate with you electronically about your application unless the communication is not available in electronic format or not permitted by law to be sent electronically, in which case we will mail those to you via U.S. mail. Regence also reserves the right to provide a paper (instead of electronic) copy of any communication that you have authorized us to provide electronically.
• Even after you consent, you have the right to receive a free paper copy of any legally required communication about your application upon request by contacting the number on your Regence application.
• You have the right to withdraw your consent at any time by contacting Regence and requesting to discontinue electronic delivery. Please note that it could take up to 30 days from receipt of notice to Regence to implement your request.
• This consent applies only to electronic communications concerning your application. If a policy is issued to you, you may be required to provide your consent again.
• If we attempt to deliver information to the email address you provided on your application, and the email is returned as undeliverable after several attempts, we will assume you have withdrawn your consent for electronic delivery, and we will resume paper and/or telephonic communications with you.
• You are responsible for updating Regence with any change in your email address.
• System Requirements: In order to receive and retain electronic communications, you must have:
  • a valid email address to which you have access;
  • an up-to-date browser (supported browsers include Microsoft Internet Explorer, Mozilla Firefox, Apple Safari, and Google Chrome);
  • access to a computer or other device (e.g., smartphone, tablet, etc.) that is capable of connecting to the Internet; and for certain electronic communications, you must have software that enables you to view files in Portable Document Format ("PDF").