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877-688-9891) for the hearing and speech Impaired. The Department's Internet Web Site http://wwwr,hmohelp.ca.gOv has complaint forms, [MR application forms and Instructions online. Arbitration Each and every disagreement, dispute or controversy which remains unresolved concerning the construction, Interpretation, performance or breach of this contract, or the provision of dental services under this contract after exhausting SafeGuard's complaint procedures, arising between the Organization, a Member or the heir- at-law or personal representative of such person, as the case may be, and SafeGuard, its employees, officers or directors, or Selected General Dentist or their dental groups, partners, agents, or employees, may be voluntarily submitted to arbitration in accordance with the American Arbitration Association rules and regulations, whether such dispute involves a claim in tort, contract or otherwise. This Includes, without limitation, all disputes as to professional liability or malpractice, that is as to whether any dental services rendered under this contract were unnecessary or unauthorized or were Improperly, negligently or Incompetently rendered. It also Includes, without limitation, any act or omission which occurs during the term of this contract but which gives rise to a claim after the termination of this contract. Arbitration shall be initiated by Written notice to SafeGuard at 5 Park Plaza, Suite 1850, Irvine, CA, 92614-2633. Coordination of Benefits We do not coordinate benefits with any other carrier, If You have coverage with another carrier, please contact that carrier to determine whether coordination of benefits Is available. Third Party Liability If benefits covered by the group contract or evidence of coverage are provided to treat an Injury or illness caused by the wrongful act or omission of another person or third party, provided that You are made whole for all other damages resulting from the wrongful act or omission before SafeGuard is entitled to reimbursement. You shall: • Reimburse SafeGuard for the reasonable cost of services paid by SafeGuard to the extent permitted under California Civil Code section 3040 immediately upon collection of damages by You, whether by action or law, settlement or otherwise; and • Fully cooperate with SafeGuard's effectuation of its lien rights for the reasonable value of services provided by SafeGuard to the extent permitted under California Civil Code section 3040. SafeGuard's lien may be filed with the person whose act caused the injuries, his or her agent, or the court. SafeGuard shall be entitled to payment, reimbursement, and subrogation in third party recoveries and You shall cooperate to fully and completely effectuate and protect the rights of SafeGuard, Including prompt notification of a case involving possible recovery from a third party. Assignment of Benefits By accepting coverage under the group contract, You agree to cooperate In protecting the Interest of SafeGuard under this provision and to execute and deliver to SafeGuard or Its nominee any and all assignments or other documents which may be necessary.or proper to fully and completely effectuate and protect the rights of SafeGuard or its nominee, You also agree to fully cooperate with SafeGuard and not take any action that would prejudice the rights of SafeGuard under this provision. INDIVIDUAL CONTINUATION OF DENTAL BENEFITS WITH PAYMENT OF THE PREPAYMENT FEE For Mentally Or Physically Handicapped Children Benefits for a dependent child may be continued past the age limit if the child Is incapable of self-sustaining employment because of a mental or physical handicap as defined by applicable law. Proof of such handicap GCERT2011-DHMO-EOC 266-20 14