RIGHT OF REIMBURSEMENT

Benefits are not payable from the Health Plan for any illness, injury, disease or other condition for which a third party is or may be liable (“Loss”). Such third parties include, but are not limited to, organizations or individuals who caused the Loss by any act or omission and insurance carriers, including insurance carriers liable under no-fault and/or uninsured motorist policies.

In the event you experience a Loss, the Plan will advance funds to you in order to assist you with the medical bills relating to the Loss in an amount not to exceed the amount of benefits to which you otherwise would have been entitled if no third party was or may be liable.

However, if you receive any funds from the Plan as a result of any Loss, you are required to reimburse the Plan for the full amount of such funds from any and all recoveries that you obtain, including any payment, judgment, settlement or other recovery from a third party. The Plan’s share of such recovery will not be reduced because you have not received the full damages or recovery that you claim from the third party unless the Plan agrees to such reduction in writing.

You also agree to do the following:

1. Notify the Plan within 90 days of the date that you: (i) become aware that any third party is or may be liable for your loss and/or, (ii) file a claim or institute an action against any third party;
2. Keep the Plan informed of the progress of any claim you assert against a third party;
3. Provide the Plan with information reasonably requested by the Plan regarding your claims against any third party, including filling out the Plan’s questionnaire;
4. Enter into a written agreement with the Plan and instruct any attorney you may have to enter into a written agreement with the Plan (the “Lien Agreement”) on a form to be provided by the Plan, whereby you grant the Plan a lien on any recoveries from a third party for the full amount of all funds advanced by the Plan related to the Loss; and
5. Reimburse the Plan for funds advanced to you with respect to the Loss immediately upon the receipt of any recovery from a third party.

Your failure to comply with the above requirements may result in the Plan taking legal action to obtain reimbursement for amounts advanced to you for the Loss and/or by offsetting any amounts you must pay the Plan against benefits otherwise payable to you under the Plan.