2016-614-E HR - Magellan Healthcare, Inc. - EAP services to OC Employees

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DocuSign Envelope ID:CADCC57A-44C1-4CBC-B33C-8C1C3E594289 date he or she becomes a Household Member and the date on which the Employee becomes eligible. The eligibility of an Employee for Services under the Agreement shall terminate on the earlier of (i) the last day of the month following the month of his or her termination of employment by Sponsor, or,if Employee is a COBRA beneficiary, the last day of his or her continuation coverage under COBRA or (ii) termination of the Agreement. Household Members shall remain eligible for Services until the eligibility of the Employee related to them ceases or until they cease to be Household Members, whichever occurs first. Notwithstanding, each Participant will be entitled to receive the full number of In-person Sessions identified in Section 3.2 of this Addendum A for an identified problem, as clinically appropriate, if he or she has scheduled an appointment with an EAP Counselor for that problem prior to the last date of eligibility as specified in this section. Magellan reserves the right to terminate the eligibility of any Participant, without right of reinstatement, for fraud or deception in the use of Services or for knowingly permitting such fraud or deception by another. Any such termination will be effective on the date Magellan mails notice of cancellation, unless the notice specifies a later date. Magellan will not terminate the eligibility of any Participant because of his or her health status or use of the EAP. A Participant does not have the right to renew his or her eligibility for Services under this Agreement once his or her relationship (employment or otherwise) to Sponsor is terminated. A Participant's right to receive Services is determined solely by this Agreement. 12. Exclusions. The EAP services provided hereunder do not include any of the following: (a) Evaluations required by any state or federal judicial officer or other governmental official or agency mandating that a Participant undergo counseling; (b) Court-mandated counseling and evaluations or recommendations to be used in child custody proceedings,child abuse proceedings, criminal proceedings,workers' compensation proceedings,or any legal actions of any kind; (c) Evaluations for fitness for duty determinations or excuses for leaves of absence or time off; (d) Medical care, including services for a condition that requires psychiatric treatment (for example, a psychosis); (e) Inpatient treatment; (f Services by providers who are not part of Magellan's EAP Counselor network; (g) Group counseling; (h) In-person Sessions that were not accessed through Magellan (either through the toll-free telephone access line or the on-line self-referral service) for the particular Episode of Care; (i) Psychological,psychiatric,neurological, educational,or IQ testing; (j) Remedial and social skills education services, such as evaluation or treatment of learning disabilities, learning disorders, academic skill disorders, language disorders, mental retardation, motor skill disorders,or communication disorders;behavioral training;cognitive rehabilitation; (k) Medication or medication management; (1) Examinations and diagnostic services in connection with obtaining employment or a particular employment assignment, admission to or continuing in school, securing any kind of license (including professional licenses),or obtaining any kind of insurance coverage; (m) Testimony, creation of records, or other services in connection with legal proceedings; (n) Guidance on workplace issues when the Participant sues,or threatens to sue,Sponsor; (o) Acupuncture; (p) Biofeedback or hypnotherapy;and (q) Services to permit individuals to fulfill any group health plan prerequisite that EAP services be utilized prior to behavioral health services becoming available. 13. Choice of Providers. Participants may select an EAP Counselor identified by an EAP Consultant or CSA, or through the online referral service at MagellanHealth.com. Magellan has no obligation to provide or arrange for EAP services by any person who is not an EAP Consultant or EAP Counselor. 14. Financial Responsibility. Participants have no financial responsibility in connection with EAP services provided under this Agreement. However, fees for professional services provided by resources other than Magellan or 2016MM 11