38 Quantum Health Care Coordination Program To best assist you with navigation of the healthcare system, the Plan includes a “Care Coordination Program” provided by Quantum Health. The Care Coordination Program is intended to help you better understand your available health and welfare benefits, obtain quality healthcare and services in the most appropriate setting, reduce unnecessary medical costs, and allow early identification of complex medical conditions using “Care Coordinators,” “Medical Management Standards” and “Care Management.” The Care Coordinators are available to you and your providers for information, help, and guidance, and can be reached toll-free by calling Quantum Health’s Care Coordinators at 1-866-871- 0839. The Care Coordinators Quantum Health provides a single point of contact through “Care Coordinators” or “Patient Service Representatives” for you and your providers to help with your navigation through your individual healthcare journey, including, but not limited to: • Answering questions about eligibility, Plan benefits and coverage levels, • Locating providers based on network status and your needs, • Outreaching to you and educating you about the benefits of using in-network providers and other resources available under the Plan, • Identifying and educating you about availability of community resources, • Initiating and coordinating referrals, • Identifying those who may benefit from Care Management, • Facilitating Prior Authorization determinations as “Pre-service” and “Concurrent” Claims in accordance with the Plan’s Claim and Appeal Procedures*, • Advising on Claim and appeal status, how to understand explanations of benefits (“EOBs”) and health care bills, and • Other general customer service functions on behalf of the Plan. Your Role in Care Coordination You play a vital role in the Care Coordination process. To maximize benefits available under the Plan, you should familiarize yourself with and follow the Care Coordination processes outlined below and any other applicable Plan provisions. Note: failure to comply with requirements under the Plan can result in significant benefit reductions, which may include penalties, higher co-payments and cost-sharing, balance billing or denials of coverage for certain services. When in doubt, contact the Care Coordinators at 1-866-871-0839. 1. Use In-Network Providers where Possible to Reduce Your Out-of-Pocket Costs. The Plan offers a broad network of providers and the benefits under the Plan are more generous when a Member receives services from a participating provider (aka, “in-network”). To find in-network providers, please visit the Plan’s website at www.myNIAMbenefits.com or call the Care Coordinators at 1-866-871-0839 . The Schedule of Benefits provided in this SPD and in the Summary