2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 21
RIGHTS OF RECOVERY
In the event of any overpayment of benefits by this Health Care Plan, the Health Care Plan will have the right to
recover the overpayment. If a Covered Person is paid a benefit greater than allowed in accordance with the
provisions of this Health Care Plan, the Covered Person will be required to refund the overpayment. If payment is
made on behalf of a Covered Person to a Hospital, Physician, or other provider of health care, and the payment is
found to be an overpayment, the Health Care Plan will request a refund of the overpayment from the provider. If
the refund is not received from the provider, or from the Covered Person, the amount of the overpayment will be
deducted from future benefits, if available. If future benefits are not available, the Covered Person will be required
to refund the overpayment.
Excess Insurance
If at the time of Injury, Illness, disease or disability, there is available or potentially available any coverage (including
but not limited to coverage resulting from a judgment at law or settlements), the benefits under this Health Care
Plan shall apply only as an excess over such other sources of coverage, except as provided for under the Health
Care Plan’s “Coordination of Benefits” section. The Health Care Plan’s benefits shall be excess to:
(1)
The responsible party, its insurer or any other source on behalf of that party;
(2)
Any first party insurance through medical payment coverage, personal injury protection, no-fault coverage,
uninsured or underinsured motorist coverage;
(3)
Any policy of insurance from any insurance company or guarantor of a third party;
(4)
Workers’ Compensation or other liability insurance company; or
(5)
Any other source, including but not limited to crime victim restitution funds, any medical, disability or other
benefit payments and school insurance coverage.
Separation of Funds
Benefits paid by the Health Care Plan, funds recovered by the Covered Person and funds held in trust over which
the Health Care Plan has an equitable lien exist separately from the property and estate of the Covered Person,
such that the death of the Covered Person or filing of bankruptcy by the Covered Person, will not affect the Health
Care Plan’s equitable lien, the funds over which the Health Care Plan has a lien or the Health Care Plan’s right to
subrogation and reimbursement.
Wrongful Death
In the event that the Covered Person dies as a result of his or her Injuries and a wrongful death or survivor claim is
asserted against a third party or any coverage, the Health Care Plan’s subrogation and reimbursement rights shall
still apply.
Obligations
(1) It is the Covered Person’s obligation at all times, both prior to and after payment of medical benefits by the
Health Care Plan:
(a)
To cooperate with the Health Care Plan or any representatives of the Health Care Plan, in protecting
its rights, including discovery, attending depositions and/or cooperating in trial to preserve the Health
Care Plan’s rights;
(b)
To provide the Health Care Plan with pertinent information regarding the Illness, disease, disability or
Injury, including Accident reports, settlement information and any other requested additional
information;
(c)
To take such action and execute such documents as the Health Care Plan may require to facilitate
enforcement of its subrogation and reimbursement rights;
(d)
To do nothing to prejudice the Health Care Plan's rights of subrogation and reimbursement;
(e)
To promptly reimburse the Health Care Plan when a recovery through settlement, judgment, award
or other payment is received; and
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