RIGHT OF SUBROGATION, REIMBURSEMENT AND OFFSET The Plan has a right to subrogation and reimbursement. References to “You” or “Your” in this Right of Subrogation, Reimbursement, and Offset section include You, Your estate, Your heirs, Your representative(s), Your Dependents, and Your beneficiaries unless otherwise stated. Subrogation applies when the Plan has paid benefits on Your behalf for an Illness or Injury for which any third party is allegedly responsible. The right to subrogation means that the Plan is substituted to and will succeed to any and all legal claims that You may be entitled to pursue against any third party for the benefits that the Plan has paid that are related to the Illness or Injury for which any third party is considered responsible. The right to reimbursement means that if it is alleged that any third party caused or is responsible for an Illness or Injury for which You receive a settlement, judgment, or other recovery from any third party, You must use those proceeds to fully return to the Plan 100% of any benefits You receive for that Illness or Injury. The right of reimbursement will apply to any benefits received at any time until the rights are extinguished, resolved, or waived in writing. The following persons and entities are considered third parties: • A person or entity alleged to have caused You to suffer an Illness, Injury, or damages, or who is legally responsible for the Illness, Injury, or damages. • Any insurer or other indemnifier of any person or entity alleged to have caused or who caused the Illness, Injury, or damages. • The Plan Sponsor in a Workers’ Compensation case or other matter alleging liability. • Any person or entity who is or may be obligated to provide benefits or payments to You, including benefits or payments for underinsured or uninsured motorist protection, no-fault or traditional auto insurance, medical payment coverage (auto, homeowners’, or otherwise), Workers' Compensation coverage, other insurance carriers, or third party administrators. • Any person or entity against whom You may have any claim for professional and/or legal malpractice arising out of or connected to an Illness or Injury You allege or could have alleged were the responsibility of any third party. • Any person or entity that is liable for payment to You on any equitable or legal liability theory. You agree as follows: • You will cooperate with the Plan in protecting the Plan’s legal and equitable rights to subrogation and reimbursement in a timely manner, including, but not limited to: ➢ Notifying the Plan, in writing, of any potential legal claim(s) You may have against any third party for acts that caused benefits to be paid or become payable. ➢ Providing any relevant information requested by the Plan. ➢ Signing and/or delivering such documents as the Plan or our agents reasonably request to secure the subrogation and reimbursement claim. ➢ Responding to requests for information about any accident or Injuries. ➢ Making court appearances. ➢ Obtaining our consent or our agents' consent before releasing any party from liability or payment of medical expenses. ➢ Complying with the terms of this section. -88- 7670-00-413597