▪ 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. Services covered by other insurance The plan does not cover services that are covered by other insurance, including, but not limited to, no fault automobile medical payments (Med-Pay), no fault automobile personal injury protection (PIP), homeowner’s no-fault coverage, commercial premises no fault medical coverage, or sports policies, including excess, underinsured or uninsured motorist coverage or similar contract or insurance. You are responsible for any cost-sharing required under the other coverage as allowed by state law. Once you have exhausted benefits (e.g., reached the maximum medical expenses amount of the other insurance policy (-ies), or services are no longer injury-related), the plan will cover services according to this COC. Motor vehicle coverage If you are involved in a motor vehicle accident, whether as a driver, passenger, pedestrian, or other capacity, you may have rights under multiple motor vehicle insurance no fault coverages and also against a third party who may be responsible for the accident. In that case, this right of reimbursement and subrogation provision still applies. Future medical expenses Benefits for otherwise covered services may be excluded as follows: • When you have received a recovery from another source relating to an illness or injury for services for which we normally would provide benefits. The amount of any exclusions under this provision, however, will not exceed the amount of your recovery. • Until the total amount excluded equals the third-party recovery. 2024 UMP Select (PEBB) Certificate of Coverage 135
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