2021 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 22
To not settle or release, without the prior consent of the Health Care Plan, any claim to the extent
that the Health Care Plan beneficiary may have against any responsible party or coverage.
If the Covered Person and/or his or her attorney fails to reimburse the Health Care Plan for all benefits paid
or to be paid, as a result of said Injury or condition, out of any proceeds, judgment or settlement received, the
Covered Person will be responsible for any and all expenses (whether fees or costs) associated with the
Health Care Plan’s attempt to recover such money from the Covered Person.
The Health Care Plan’s rights to reimbursement and/or subrogation are in no way dependent upon the
Covered Persons’ cooperation or adherence to these terms.
Failure by the Covered Person and/or his or her attorney to comply with any of these requirements may, at the
Health Care Plan’s discretion, result in a forfeiture of payment by the Health Care Plan of medical benefits and any
funds or payments due under this Health Care Plan may be withheld until the Covered Person satisfies his or her
(1) In the event the Covered Person is a minor as that term is defined by applicable law, the minor’s parents or
court-appointed guardian shall cooperate in any and all actions by the Health Care Plan to seek and obtain
requisite court approval to bind the minor and his or her estate insofar as these subrogation and
reimbursement provisions are concerned.
If the minor’s parents or court-appointed guardian fail to take such action, the Health Care Plan shall have no
obligation to advance payment of medical benefits on behalf of the minor. Any court costs or legal fees
associated with obtaining such approval shall be paid by the minor’s parents or court- appointed guardian.
The Health Care Plan Sponsor retains sole, full and final discretionary authority to construe and interpret the
language of this provision, to determine all questions of fact and law arising under this provision and to administer
the Health Care Plan’s reimbursement rights. All actions or determinations by the Health Care Plan Sponsor or a
person designated as responsible for a particular aspect of the control, management or administration of this Health
Care Plan on all matters within the scope of their authority under this Health Care Plan shall be final, conclusive
and binding on all persons, and shall be given full effect under applicable law, unless such interpretation of
determination is determined by a court of competent jurisdiction to be an abuse of discretion and arbitrary or
capricious. The Health Care Plan Sponsor may amend the Health Care Plan at any time without notice.
In the event that any section of this provision is considered invalid or illegal for any reason, said invalidity or illegality
shall not affect the remaining sections of this provision and Health Care Plan. The section shall be fully severable.
The Health Care Plan shall be construed and enforced as if such invalid or illegal sections had never been inserted
in the Health Care Plan.
Notwithstanding anything contained herein to the contrary, the Health Care Plan’s right to subrogation and
reimbursement may be subject to applicable State subrogation laws.
Right to Receive and Release Necessary Information
For the purposes of implementing the terms of this Health Care Plan, the Claims Administrator retains the right to
request any medical or dental information from any insurance company or provider of service it deems necessary
to properly process a claim. The Claims Administrator may, without consent of the Covered Person, release or
obtain any information it deems necessary. Any person claiming benefits under this Health Care Plan shall furnish
to the Claims Administrator such information as may be necessary to implement this provision.