Request Exclusion

If you would like to request exclusion from this lawsuit, please fill out this form completely, certify it, and then submit it. Online exclusion requests must be submitted no later than 11:59 PST January 29, 2020.

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Certification:
By checking this box, I declare that I want to opt out of the lawsuit pending in the United States District Court for the District of Oregon, called In Re: Premera Blue Cross Customer Data Security Incident Litigation, No. 3:15-md-2633-SI, that asserts that Premera failed to adequately to protect personal information on their computer network system that was the target of an external criminal-cyberattack. I understand that by opting out, I will not be a part of this class action lawsuit and I will keep any rights that I may have to sue Premera myself. I understand that I will not be bound by any of the Court’s orders or judgments in this class action lawsuit and will not get any money or benefits from this lawsuit or from any settlement.*

PLEASE ONLY COMPLETE THIS CERTIFICATION IF YOU WISH TO OPT OUT OF THIS LAWSUIT.