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1.13 MEMBER means a person who is eligible and has been accepted by the Company for coverage and for whom the applicable rate has been paid for Benefits under a Health Plan. 1.14 PARTICIPATING PROVIDER means any hospital, physician, other health care professional, or other provider of medical services or supplies who (a) is legally qualified to provide medical services or supplies under Washington state law; (b) has contracted with the Company, directly or through intermediaries, to furnish Covered Services to Members as part of one or more of the Company's Provider Networks; and (c) is eligible for reimbursement under a Subscriber Agreement. 1.15 PARTICIPATING PROVIDER NETWORK is the collective group of hospitals, facilities, clinics, physicians and other health care professionals under contract with the Company to participate in the Company's network of providers identified as the Participating Provider Network. 1.16 PAYOR means the entities set forth below that offer or administer a health care plan and contracts with the Company pursuant to Section 5.6 for access to one or more Provider Networks in which Medical Group participates. Payors are limited to the following entities and their subcontractors who contract with Payor for access to one or more Provider Networks: subsidiaries and affiliates of the Company as set forth on Exhibit A, a Blue Cross and/or Blue Shield Plan, a government program, a trust, and a self-funded health plan administered by the Company or one of its subsidiaries or affiliates. 1.17 ADMINISTRATIVE MANUAL is a separate reference source developed and issued by Company for providers that includes additional details, policies, procedures and other information that a Participating Provider will need to know in order to properly perform its obligations under this Agreement. 1.18 PROVIDER NETWORK means the Asuris Northwest Health Participating Provider Network and any other Asuris Northwest Health network of Participating Providers or lines of business that Provider agrees to participate pursuant to an addendum attached to this Agreement. 1.19 RECREDENTIALING is a periodic process by which the Company may determine, in its sole discretion, whether to continue participating with a Medical Group. 1.20 SUBSCRIBER AGREEMENT is a contract between the Company or Payor and an individual or group in which the Company agrees to provide, indemnify for or administer health care benefits and which provides a benefit incentive if a subscriber or enrolled dependent obtains health care services from Participating Providers in the Provider Network. This includes, but is not limited to, administrative services only (ASO) contracts the Company or Payor enters into with employers, other out of area Blue Cross/Blue Shield Plans and Blue Cross and Blue Shield Association services and state and federal governmental programs. This may also include Subscriber Agreements issued by the Company's branches and affiliates as set forth on Exhibit A, in accordance with Section 5.6, as well as Subscriber Agreements issued by any successor organization of the Company. 1.21 NON -COVERED SERVICE is a service or supply that is not a Covered Service for any of the following reasons: (1) the service or supply is Investigational or not Medically Necessary; or (2) the service or supply is not an available benefit or a Covered Service under the Subscriber Agreement for any reason. 1.22 INVESTIGATIONAL: The definition provided in the Subscriber Agreement. To the extent that the Subscriber Agreement does not provide a definition of Investigational, the following definition shall apply: a health intervention that the Company or Payor has classified as Investigational. The Company will review Scientific Evidence from well- designed clinical studies found in peer-reviewed medical literature, if available, and information obtained from Medical Group regarding the health intervention to determine if Asuris MGA Agreement (Rev. 05/2017) Al8816854AA Page 3 of 20