2021 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 20
Benefits are payable only upon the Covered Person’s acceptance of the terms of the Health Care Plan. As a
condition to receiving benefits under this Health Care Plan, a Covered Person agrees to provisions of the
following Reimbursement Rights.
Responsible Party: For purposes of this Reimbursement Rights section, Responsible Party means any
party actually, possibly or potentially responsible for making any payment to a Covered Person due to an
Injury, Illness, or condition. This also includes any other Plan (as defined under Coordination of Benefits),
person, corporation, entity, no-fault carrier, uninsured motorist carrier, underinsured motorist carrier,
Workers’ Compensation, other insurance policies for funds any insurance coverage, or the liability
insurance for such party.
Constructive Trust: By accepting benefits from this Health Care Plan, the Covered Persons agree to serve
as a constructive trustee, and to hold in constructive trust such money or property resulting from any
payments or settlement proceeds from any Responsible Party. Further, the Covered Persons agree that
they will not dissipate any such money or property without prior written consent of this Health Care Plan,
regardless of how such money or property is classified or characterized, from any Responsible Party.
Failure to hold such funds in trust will be deemed a breach to the Health Care Plan.
Reimbursement: In addition, if this Health Care Plan has already paid benefits to the Covered Person (or
other providers on their behalf) for any Injury or Illness where a Responsible Party has a legal obligation
to compensate the Covered Person for his or her Injury or Illness, this Health Care Plan has a right of
reimbursement for such payments.
Cooperation : The Covered Person agrees to refrain from releasing any Responsible Party or funds that
may be liable for or obligated to the Covered Person for the Injury, Illness, or condition without obtaining
this Health Care Plan's written approval. By participating in this Health Care Plan, the Covered Person
automatically agrees to (a) promptly execute any documents and instruments, including a reimbursement
agreement, and take any action that this Health Care Plan considers necessary to protect its rights; (b)
not take any actions that could jeopardize or prejudice this Health Care Plan’s position or rights (including
refraining from making any settlement or recovery that attempts to reduce or recover or exclude the full
cost of all benefits provided by this Health Care Plan); and (c) notify this Health Care Plan within thirty (30)
days following the date any notice is given to any party of the Covered Person’s intention to pursue or
investigate a Claim due to Injury, Illness, condition, or other loss.
Recovery from Covered Person: If the Covered Persons fail to reimburse this Health Care Plan for any
benefits paid or to be paid, as a result of said Illness, Injury or condition, out of any recovery or
reimbursement received, the Covered Person will be liable for any and all expenses (whether fees or
costs) associated with this Health Care Plan's attempt to recover such money from the Covered Person.
Lien Rights: This Health Care Plan will automatically have a lien to the extent of benefits paid by this
Health Care Plan for the treatment of the Illness, Injury, or condition, and other losses for which the
Responsible Party is liable. The lien shall be imposed upon any recovery whether by settlement, judgment,
or otherwise, including from any Responsible Party or insurance coverage related to treatment for any
Illness, Injury, or condition for which this Health Care Plan paid benefits. The lien may be enforced against
any party who possesses funds or proceeds representing the amount of benefits paid by this Health Care
Plan including, but not limited to, the Covered Person; any Covered Person’s representative or agent;
Responsible Party; Responsible Party’s insurer, representative, or agent; and/or any other source
possessing funds representing the amount of benefits paid by this Health Care Plan.
Applicability to All Settlements and Judgments: This Reimbursement Rights section shall apply and this
Health Care Plan is entitled to recovery regardless of whether any liability for payment is admitted by any
Responsible Party and regardless of whether the settlement or judgment received by the Covered Person
identifies the benefits this Health Care Plan provided or purports to allocate any portion of such settlement
or judgment to payment of expenses other than expenses paid by this Health Care Plan.