2021 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 26
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.
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.
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:
The Workers’ Compensation benefits are in dispute or are made by means of settlement or compromise;
No final determination is made that the Injury or Illness was sustained in the course of or resulted from
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
The health care expense is specifically excluded from the Workers’ Compensation settlement or
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.