FRAUD Fraud is a crime for which an individual may be prosecuted. Any Covered Person who willfully and knowingly engages in an activity intended to defraud the Plan is guilty of fraud. The Plan will utilize all means necessary to support fraud detection and investigation. It is a crime for a Covered Person to file a claim containing any false, incomplete, or misleading information with intent to injure, defraud, or deceive the Plan. In addition, it is a fraudulent act when a Covered Person willfully and knowingly fails to notify the Plan regarding an event that affects eligibility for a Covered Person. Notification requirements are outlined in this SPD and other Plan materials. Please read them carefully and refer to all Plan materials that You receive (e.g., COBRA notices). A few examples of events that require Plan notification are divorce, a Dependent aging out of the Plan, and enrollment in other group health coverage while on COBRA. (Please note that the examples listed are not all-inclusive.) These actions will result in denial of the Covered Person’s claim or in termination of the Covered Person’s coverage under the Plan, and are subject to prosecution and punishment to the full extent under state and/or federal law. Each Covered Person must: • File accurate claims. If someone else, such as the Covered Person’s spouse or another family member, files claims on the Covered Person’s behalf, the Covered Person should review the claim form before signing it; • Review the Explanation of Benefits (EOB) form. The Covered Person should make certain that benefits have been paid correctly based on his or her knowledge of the expenses Incurred and the services rendered; • Never allow another person to seek medical treatment under his or her identity. If the Covered Person’s Plan identification card is lost, the Covered Person should report the loss to the Plan immediately; • Provide complete and accurate information on claim forms and any other forms. He or she should answer all questions to the best of his or her knowledge; and • Notify the Plan when an event occurs that affects a Covered Person’s eligibility. In order to maintain the integrity of this Plan, each Covered Person is encouraged to notify the Plan whenever a provider: • Bills for services or treatment that have never been received; or • Asks a Covered Person to sign a blank claim form; or • Asks a Covered Person to undergo tests that the Covered Person feels are not needed. Covered Persons concerned about any of the charges that appear on a bill or EOB form, or who know of or suspect any illegal activity, should call the toll-free hotline at 1-800-356-5803. All calls are strictly confidential. -107- 7670-00-413597