similar contract or insurance, when the contract or insurance is either issued to or makes benefits available to you, whether or not you make a claim under such coverage; or • Services or supplies for work-related injury or illness, even when the service or supply is not a covered workers’ compensation benefit under the workers’ compensation plan. ALERT! You must respond to any communication sent to you about other sources of benefits, or the plan may deny claims. However, after expiration or exhaustion of the above benefits, if you also have a potential right of recovery for illnesses or injuries from a third party who may have legal responsibility or from any other source, benefits may be provided or advanced by the plan pending the resolution of a claim to the right of recovery subject to all of the following conditions: • By accepting or claiming benefits, you agree that the plan is entitled to reimbursement of the full amount of benefits paid out of any settlement or recovery from any source to the extent that the settlement or recovery exceeds full compensation to you for the injury or illness that you sustained. This includes any arbitration award, judgment, settlement, disputed claim settlement, underinsured or uninsured motorist payment, or any other recovery related to the injury or illness for which benefits under the plan have been provided or advanced. • The plan may choose to recover expenses directly from the third party (or third party’s insurer) responsible for your injury or illness. This is called subrogation. The plan is authorized, but not 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; 134 2024 UMP Select (PEBB) Certificate of Coverage