Advocate Aurora Health Settlement Claim Form Instructions

To submit the Advocate Aurora Settlement Claim Form, follow these instructions: Complete all required fields of the form. Sign and date the form to attest to the accuracy of the provided information. Submit the form online at www.AdvocateAuroraSettlement.com or mail it to Settlement Administrator - 175057, c/o Kroll Settlement Administration LLC, PO Box 5324, New York, NY 10150-5324. Ensure that the form is postmarked by January 18, 2024. Keep a copy of the completed form for your records. It is your responsibility to notify the Settlement Administrator of any changes to your contact information after submission.

The Claim Deadline is January 18, 2024. Ensure your claim form is submitted or postmarked by this date to be eligible for a cash payment under the Advocate Aurora Health Settlement.

The purpose of this form is to allow eligible individuals to file a claim for a cash payment as part of the Advocate Aurora Health Settlement. The claim form is intended for members of the Settlement Class who visited Advocate Aurora Health Inc.'s websites, used the LiveWell app, or accessed the MyChart patient portal between October 24, 2017, and October 22, 2022. By submitting this form, eligible individuals can receive their pro rata share of the Net Settlement Fund. Filing a claim requires providing personal information, attesting to the use of Advocate's digital platforms, and signing the form. This ensures that only valid claims are processed and eligible members receive their due compensation. The settlement aims to address potential privacy breaches that may have occurred during the specified timeframe. It is crucial to follow the instructions carefully and submit the form by the deadline of January 18, 2024. This ensures that your claim is considered and processed in a timely manner. Whether you submit the form online or by mail, providing accurate information and keeping a copy of your submission are essential steps in the process.

• 1. SETTLEMENT CLASS MEMBER INFORMATION: Provide your first name, middle initial, last name, mailing address, city, state, zip code, current email address, and optionally, current phone number.
• 2. PAYMENT ELIGIBILITY INFORMATION AND ATTESTATION: Review eligibility information from the Postcard Notice and attest that you visited Advocate's websites, used the LiveWell app, or accessed the patient portal during the specified timeframe.
• 3. SIGN AND DATE YOUR CLAIM FORM: Sign and date the claim form, declaring under penalty of perjury that the information provided is true and accurate to the best of your recollection.

Failure to submit the form by the deadline means you will not be eligible for a cash payment under the settlement. Ensure timely submission to avoid missing out.

• Eligibility Lost: Missing the submission deadline results in losing eligibility for the settlement payment.
• Compensation Forfeited: Failure to submit means you forfeit any compensation you might have been entitled to.

• 1. Visited Advocate's Websites: Use the form if you visited Advocate's websites between October 24, 2017, and October 22, 2022.
• 2. Used LiveWell App: Submit the form if you used the LiveWell app during the specified timeframe.
• 3. Accessed MyChart Patient Portal: File a claim if you accessed the MyChart patient portal within the eligibility period.
• 4. Received Postcard Notice: Respond to the Postcard Notice by submitting the form to exercise your legal rights.
• 5. Eligible for Settlement: Submit the form if you meet the eligibility criteria for the Advocate Aurora Health Settlement.