Within 30 days after entering into a Surrogacy Arrangement, you must send written notice of the arrangement, including all of the following information:  Names, addresses, and telephone numbers of the other parties to the arrangement  Names, addresses, and telephone numbers of any escrow agent or trustee  Names, addresses, and telephone numbers of the intended parents and any other parties who are financially responsible for Services the baby (or babies) receive, including names, addresses, and telephone numbers for any health insurance that will cover Services that the baby (or babies) receive  A signed copy of any contracts and other documents explaining the arrangement  Any other information we request in order to satisfy our rights You must send this information to: Surrogacy Other Party Liability Supervisor Equian P.O. Box 36380 Louisville, Kentucky 40233-6380 Fax: 1-502-214-1137 Phone: 1-800-552-8314 You must complete and send us all consents, releases, authorizations, lien forms, and other documents that are reasonably necessary for us to determine the existence of any rights we may have under this “Surrogacy Arrangements – Traditional and Gestational Carriers” section and to satisfy those rights. You may not agree to waive, release, or reduce our rights under this “Surrogacy Arrangements – Traditional and Gestational Carriers” section without our prior, written consent. If your estate, parent, guardian, or conservator asserts a claim against another party based on the surrogacy arrangement, your estate, parent, guardian, or conservator and any settlement, award, or judgment recovered by the estate, parent, guardian, or conservator shall be subject to our liens and other rights to the same extent as if you had asserted the claim against that party. We may assign our rights to enforce our liens and other rights. Workers’ Compensation or Employer’s Liability If you suffer from an injury or illness that is compensable under a workers’ compensation or employer’s liability law, we will provide Services even if it is unclear whether you are entitled to a payment or settlement under the law. You have an obligation to reimburse us to the extent of a payment or any other benefit, including any amount you receive as a settlement under the law. In addition, we or our Participating Providers will be permitted to seek reimbursement for these Services directly from the responsible employer or the government agency that administers the law. GRIEVANCES, CLAIMS, APPEALS, AND EXTERNAL REVIEW Terms We Use in this Section The following terms have the following meanings when used in this “Grievances, Claims, Appeals, and External Review” section: A claim is a request for us to: • Provide or pay for a Service that you have not received (pre-Service claim); • Continue to provide or pay for a Service that you are currently receiving (concurrent care claim); or • Pay for a Service that you have already received (post-Service claim). EWCLGHDHP1983ACT0124 83 WAPEBB-CD-ACT