Health Summary Plan Description

Right Of Reimbursement

Benefits are not payable from the Health Plan for any illness, injury, disease or other condition for which a third party may be liable ("Loss"). Such third parties include, but are not limited to, organizations or individuals who caused the Loss by any act or omission, and insurance carriers, including insurance carriers liable under no-fault and/or uninsured motorist policies.

In the event you experience a Loss, the Plan will advance funds to you in order to assist you with medical bills relating to the Loss. The Plan will not advance more than the amount of benefits to which you would otherwise have been entitled if no third party was liable. If you receive any funds from the Plan as a result of any Loss, you are required to reimburse the Plan for the full amount of such funds from any and all recoveries that you obtain, including any payment, judgment, settlement or other recovery from a third party (the "Full Recovery"). The Plan's share of such Full Recovery will not be reduced because you have not received the full damages or recovery that you claim from the third party (regardless of whether or not you assert a claim under the "make whole doctrine," the "double-recovery rule" and/or under any other such equitable right to relief) unless the Plan agrees to such reduction in writing.

The Plan's right to recover any advanced funds extends to any amount paid with respect to, associated with, or stemming from the injuries incurred, whether paid directly or indirectly to you, your spouse, dependents, beneficiaries or estate, or whether held in trust or constructive trust for your benefit, the benefit of your spouse, or the benefit of any dependents, beneficiaries or estate. All funds the Plan advances shall be recoverable regardless of whether the funds have been commingled with other assets and the Plan may recover from any available funds without the need to trace the source of the funds. In the event that you, your spouse, dependents, attorney, beneficiary, estate or other third party distribute funds without regard to the Plan's right of reimbursement, you will be personally liable to the Plan for the amounts so distributed.

The Plan's right of reimbursement is net of reasonable attorney's fees and costs, such fees and costs not to exceed one-third (1/3) of the Full Recovery by the Plan.

You also agree to do all of the following:

  1. Notify the Plan within 90 days of the date that you (i) become aware that any third party is or may be liable for your Loss, and/or (ii) file a claim or institute an action against any third party.
  2. Keep the Plan informed of the progress of any claim you assert against a third party.
  3. Provide the Plan with information reasonably requested by the Plan regarding your claims against any third party, including filling out the Plan's questionnaire.
  4. Enter into a written agreement with the Plan and instruct any attorney you may have to enter into a written agreement with the Plan (the "Lien Agreement") on a form to be provided by the Plan, whereby you grant the Plan a lien on any recoveries from a third party for the full amount of all funds advanced by the Plan related to the Loss.
  5. Reimburse the Plan for funds advanced to you with respect to the Loss immediately upon the receipt of any recovery from a third party.

Your failure to comply with the above requirements may result in the Plan taking legal action to obtain reimbursement for amounts advanced to you for the Loss and/or offsetting any amounts you must pay the Plan against benefits otherwise payable to you under the Plan.