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Health Net settlement fund procedure

(Retrospective Relief)

This summary has been prepared by the American Medical Association (AMA) Private Sector Advocacy unit from information provided to the AMA. While efforts have been made to include information likely to be of interest to most physicians, the actual settlement documents are much more extensive, contain the definitive settlement terms and should be consulted in the event of questions or if a specific situation is not addressed. Questions about the settlement may be directed to Health Net Physician Settlement Administrator at (866) 254-8048 or Whatley Drake, L.L.C. at (866) 809-8003. Questions can also be directed to the following Web site: www.hmosettlements.com. The Health Net Proof of Claim Form and instructions can also be downloaded at the Web site.

Who is Eligible to Apply for the Health Net Settlement Fund?
Any eligible Physician, Physician Group or Physician Organization may submit a Proof of Claim Form based on one of the following options:

• Health Net reimbursement for calendar periods of 2002, 2003 and 2004;

Health Net reimbursement for another consecutive three year period between January 1, 1996 to December 31, 2004; or

• No Health Net reimbursement, but submitted claims to one or more of the following payers for covered services that were provided to any individual between August 4, 1990 and May 10, 2005

Aetna, Inc.                                Humana Health Plan, Inc.
Aetna-USHC, Inc.                    Pacificare Health Systems, Inc.
Anthem, Inc.                             Prudential Insurance Company of America
CIGNA HealthCare                  UnitedHealthcare
Coventry Health Care, Inc.      UnitedHealth Group
Humana, Inc.                             WellPoint Health Networks, Inc.

How Do I Submit the Proof of Claim Form?
The Proof of Claim Form and instructions can be downloaded from www.hmosettlements.com. Completed Proof of Claim Forms must be submitted by September 21, 2005 to the Settlement Administrator at the following address:

Health Net Physician Settlement Administrator
P.O. Box 1018
Minneapolis, MN 55440-1018
Phone: (866) 254-8048

Supporting Documentation
No supporting documentation is needed, unless you elect to file a Proof of Claim Form for a consecutive three year period between January 1, 1996 and December 31, 2003. If supporting documentation is required, you must submit the appropriate payment records, such as 1099 forms that contain the amount of payments received from Health Net for services delivered during the consecutive three year period.

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