obligated, to recover any expenses, to the extent that they were paid under the plan, directly from any party liable to you, upon mailing of a written notice to the potential payer, to you, or to your representative. • The plan’s rights apply without regard to the source of payment for medical expenses, whether from the proceeds of any settlement, arbitration award, or judgment, or other characterization of the recovery by you or any third party or the recovery source. The plan is entitled to reimbursement from the first dollar received from any recovery to the extent that the settlement or recovery exceeds full compensation to you for the injury or illness that you sustained. This applies regardless of whether: ▪ The third party or third party’s insurer admits liability; ▪ The health care expenses are itemized or expressly excluded in the recovery; or ▪ The recovery includes any amount (in whole or in part) for services, supplies, or accommodations covered under the plan. • You may be required to sign and deliver all legal papers and take any other actions requested to secure the plan’s rights (including an assignment of rights to pursue your claim if you fail to pursue your claim of recovery from the third party or other source). If you are asked to sign a trust/reimbursement agreement or other document to reimburse the plan from the proceeds of any recovery, you will be required to do so as a condition to advancement of any benefits. If you or your agent or attorney fail to comply during the course of the case, we may request refunds from the providers or offset future benefits. • You will not do anything to prejudice the plan’s rights and that you will cooperate fully with the plan, including signing any documents within the required time and providing prompt notice of any settlement or other recovery. You must notify the plan of any facts that may impact the right to reimbursement or subrogation, including, but not necessarily limited to, the following: ▪ The filing of a lawsuit; ▪ The making of a claim against any third party; ▪ Scheduling of settlement negotiations with a minimum of 21 days advance notice of the date, time, location and participants to be involved in any settlement conferences or mediations); or ▪ Intent of a third party to make payment of any kind to your benefit or on your behalf and that in any manner relates to the injury or illness that gives rise to the plan’s right of reimbursement or subrogation (notice is required a minimum of five business days before the settlement). • You and your agent or attorney must agree to keep segregated in its own account any recovery or payment of any kind to your benefit that in any manner relates to the injury or illness giving rise to the plan’s right of reimbursement or subrogation, until the plan’s right is satisfied or released. • In the event you or your agent or attorney fails to comply with any of these conditions, any such benefits provided or advanced for any illness or injury may be recovered through legal action to the extent that the settlement or recovery exceeds full compensation to you for the injury or illness that you sustained. • Any benefits provided or advanced under the plan are provided or advanced solely to assist you. By paying such benefits, the plan is not waiving any right to reimbursement or subrogation. Fees and expenses You may incur attorney’s fees and costs in connection with obtaining a recovery. We may pay a proportional share of such attorney’s fees and costs you incur at the time of any settlement or recovery to otherwise reduce the amount of reimbursement paid to the plan to less than the full amount of benefits paid by the plan. 132 2024 UMP Plus–UW Medicine ACN (PEBB) Certificate of Coverage