WHAT IS COVERED

Third Party Reimbursement and Subrogation

The Plan may advance benefits to or on behalf of a covered individual or the covered individual’s eligible dependent who, as the result of an act or omission of a third party, is injured or becomes ill. If the Plan advances medical benefits, it has a right to subrogation and reimbursement to the full extent of all payments made by the Plan. The Plan’s right to subrogation and reimbursement provides the Plan with a priority over any funds received by the covered individual or the covered individual’s eligible dependent from any third party (including but not limited to a negligent third party or an insurance company) when such funds are paid because of, or the payment relates to, the act or omission of the third party.

The Plan’s right to subrogation and reimbursement is primary and shall come before any and all rights to any recovery held by the covered individual, the covered individual’s eligible dependent, his/her attorney, representative or any other party. The Plan’s right to subrogation and reimbursement exists regardless of the manner in which the payment to the covered individual or the covered individual’s eligible dependent is designated or whether the amount is received by the covered individual, by the covered individual’s eligible dependent, or by any third party acting on behalf of the individual or the individual’s dependent.

The Plan may at any time request a separate recovery authorization signed by the covered individual or the covered individual’s eligible dependent which acknowledges his/her obligation to repay the Plan for benefits advanced, or to be advanced, by the Plan to or on behalf of the covered individual or the covered individual’s eligible dependent.

The covered individual or the covered individual’s eligible dependent must cooperate with the Plan, provide all information requested by the Plan, assign to the Plan any money received arising out of or relating to the act or omission of the third party and must take any further actions the Plan may reasonably require to fully effectuate the terms of the Plan and facilitate enforcement of the Plan’s rights. The covered individual or the covered individual’s eligible dependent must not do anything to prejudice or interfere with the rights and interests of the Plan. The covered individual or the covered individual’s eligible dependent must immediately notify the Plan when the covered individual or the covered individual’s eligible dependent retains an attorney:

Any monies received by the covered individual, the covered individual’s eligible dependent, or the attorney as the result of a settlement or judgment, if not conveyed directly to the Plan, must be immediately placed into a trust account and shall not be withdrawn or transferred until the Plan has received payment-in-full.

There shall be no pro rata distribution of any recovery between the covered individual or the covered individual’s eligible dependent and the Plan.

The Plan shall not be responsible for any of the covered individual’s or the covered individual’s eligible dependent’s attorney’s fees or costs of litigation.

Subrogation empowers the Plan to act on behalf of its covered individuals, and thus to enforce the covered individual’s and the covered individual’s eligible dependent’s rights and remedies against third parties through litigation. The covered individual must assign and agree to subrogate the Plan to the full extent of all payments made by the Plan and all rights, claims and interests which the covered individual or the covered individual’s eligible dependent has or may have against any third party to enforce its claim.

The Plan’s right to subrogation is not contingent upon the covered individual or the covered individual’s eligible dependent obtaining a settlement, judgment, insurance proceeds or other payment that fully compensates the covered individual or the covered individual’s eligible dependent for the total losses he/she sustained. The covered individual’s or the covered individual’s eligible dependent’s right to be made whole is superseded by the Plan’s right to subrogation.

Reimbursement affords the Plan a direct right of recovery against the covered individual or the covered individual’s eligible dependent. As a condition to and in consideration of coverage under this Plan, the covered individual or the covered individual’s eligible dependent agrees to fully reimburse the Plan to the complete extent of any recovery received from or on behalf of a third party arising out of or relating to the act or omission of the third party.

If benefits are paid by the Plan and the covered individual or the covered individual’s eligible dependent recovers from a third party by settlement, judgment, insurance proceeds or otherwise, the Plan has the right to recover from the covered individual or the covered individual’s eligible dependent an amount equal to the amount paid by the Plan. The covered individual’s or the covered individual’s eligible dependent’s right to be made whole is superseded by the Plan’s right to reimbursement