2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 25
The use of the words, “you” and “your” throughout this Health Care Plan applies to eligible or Covered Employees
and, where appropriate in context, their covered Dependents.
No Contract of Employment
This Health Care Plan and any amendments constitute the terms and provisions of coverage under this Health
Care Plan. The Health Care Plan shall not be deemed to constitute a contract of any type between the Employer
and any person or to be consideration for or an inducement or condition of, the employment of any Employee.
Nothing in this Health Care Plan shall be deemed to give any Employee the right to be retained in the service of
the Employer or to interfere with the right of the Employer to discharge any Employee at any time.
Release of Information
For the purpose of determining the applicability of and implementing the terms of these benefits, the Employer may,
without the consent of or notice to any person, release or obtain any information necessary to determine the
acceptability of any applicant or person covered for benefits under this Health Care Plan. In so acting, the Employer
shall be free from any liability that may arise with regard to such action; however, the Employer at all times will
comply with the applicable privacy standards. Any Covered Person claiming benefits under this Health Care Plan
shall furnish to the Employer such information as may be necessary to implement this provision.
Unclaimed Property
If the Employer is unable to make payment to any Covered Person or other person to whom a payment is due
under the Health Care Plan because the Employer cannot ascertain the identity or whereabouts of such Covered
Person or other person after reasonable efforts have been made to identify or locate such person, such payment
and all subsequent payments otherwise due to such Covered Person or other person shall be forfeited after a
reasonable time of no more than two (2) years, as determined in the sole discretion of the Employer, after the date
any such payment first became due.
Any benefit payments that are unclaimed (e.g., uncashed benefit checks) by the close of the second Health Care
Plan Year following the Health Care Plan Year in which the payments are issued shall be forfeited. Amounts so
forfeited shall be used to offset administrative expenses and future costs, and/or applied in a manner that is
consistent with the Health Care Plan and applicable rules and regulations.
Workers’ Compensation
This Health Care Plan excludes coverage for any Injury or Illness that is eligible for coverage under any Workers’
Compensation policy or law regardless of the date of onset of such Injury or Illness. However, if benefits are paid
by the Health Care Plan and it is later determined that you received or are eligible to receive Workers’ Compensation
coverage for the same Injury or Illness, the Health Care Plan is entitled to full recovery for the benefits it has paid.
This exclusion applies to past and future expenses for the Injury or Illness regardless of the amount or terms of any
settlement you receive from Workers’ Compensation. The Health Care Plan will exercise its right to recover against
you. The Health Care Plan reserves its right to exercise its rights under this section and the section entitled
“Recovery of Payment” even though:
(1)
The Workers’ Compensation benefits are in dispute or are made by means of settlement or compromise;
(2)
No final determination is made that the Injury or Illness was sustained in the course of or resulted from your
employment;
(3)
The amount of Workers’ Compensation benefits due specifically to health care expense is not agreed upon
or defined by you or the Workers’ Compensation carrier; or
(4)
The health care expense is specifically excluded from the Workers’ Compensation settlement or compromise.
You are required to notify the Employer immediately when you file a claim for coverage under Workers’
Compensation if a claim for the same Injury or Illness is or has been filed with this Health Care Plan. Failure to do
so or to reimburse the Health Care Plan for any expenses it has paid for which coverage is available through
Workers’ Compensation, will be considered a fraudulent claim and you will be subject to any and all remedies
available to the Health Care Plan for recovery and disciplinary action.
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