AMERICAN SPECIALTY HEALTH PLANS GROUP SUBSCRIBER AGMT 1998

American Specialty Health Plans Group Subscriber Agreement Cover Sheet (This cover sheet is an integral part of this agreement) GROUP NAME: CITY OF PLEASANTON EMPLOYEES ASSOCIATION GROUP CODE(S): 33325-0000 EFFECTIVE DATE: June 1,1998 PLAN CODE: CH3 PLAN DESCRIPTION: 30 Office Visits/Per Year $12.00 Copayment $50.00 Annual Chiropractic Appliance Benefit CHIROPRACTIC HEALTH PLAN PREMIUMS • SUBSCRIBER ONLY $2.91 • SUBSCRIBER + FAMILY $7.28 ANNUAL COPAYMENT MAXIMUM FOR INDIVIDUAL: None ANNUAL COPAYMENT MAXIMUM PER FAMILY: None CONTINUATION OF BENEFITS ELECTIONS: Yes NO.OF DAYS: In accordance with COBRA legislation. START AND END DATE OF COVERAGE: Refer to medical plan limitations The Northern California Region of Kaiser Foundation Health Plan, Inc. ("Kaiser Permanente"), is providing administrative services for ASHP. Therefore, notwithstanding anything to the contrary in the ASHP Group Subscriber Agreement, (1) Group will send ASHP Eligibility Information and premiums to the Northern California Region of Kaiser Permanente, which is acting as ASHP's agent for the purposes of receiving Eligibility Information and premiums, (2) persons are eligible for membership in ASHP only if, and only for so long as, they are enrolled through Group in Kaiser Permanente, (3) any person who meets Group's eligibility requirements for ASHP membership and is enrolled through Group in Kaiser Permanente is eligible for ASHP membership,(4) persons who meet Group's eligibility requirements for ASHP membership and enroll through Group in Kaiser Permanente will be automatically enrolled in ASHP without completing an additional ASHP enrollment application, and (5) ASHP may amend the Group Subscriber Agreement only in accordance with the procedures and time frames set forth for Kaiser Permanente in the Kaiser Permanente Group Medical and Hospital Services Agreement. ATTACHMENTS: (The following attachments are an integral part of this agreement) Exhibit A: Schedule of Benefits