Subrogation and Right of Recovery. If HMO provides health care benefits under this Certificate to a Member for injuries or illness for which another party is or may be responsible, then HMO retains the right to repayment of the full cost of all benefits provided by HMO on behalf of the Member that are associated with the injury or illness for which another party is or may be responsible. HMO’s rights of recovery apply to any recoveries made by or on behalf of the Member from the following sources, including but not limited to: payments made by a third-party tortfeasor or any insurance company on behalf of the third-party tortfeasor; any payments or awards under an uninsured or underinsured motorist coverage policy; any Workers’ Compensation or disability award or settlement; medical payments coverage under any automobile policy, premises or homeowners medical payments coverage or premises or homeowners insurance coverage; any other payments from a source intended to compensate a Member for injuries resulting from an accident or alleged negligence. The Member specifically acknowledges HMO’s right of subrogation. When HMO provides health care benefits for injuries or illnesses for which another party is or may be responsible, HMO shall be subrogated to the Member’s rights of recovery against any party to the extent of the full cost of all benefits provided by HMO. HMO may proceed against any party with or without the Member’s consent. The Member also specifically acknowledges HMO’s right of reimbursement. This right of reimbursement attaches when HMO has provided health care benefits for injuries or illness for which another party is or may be responsible and the Member and/or the Member’s representative has recovered any amounts from another party or any party making payments on the party’s behalf. By providing any benefit under this Certificate, HMO is granted an assignment of the proceeds of any settlement, judgment or other payment received by the Member to the extent of the full cost of all benefits provided by HMO. HMO’s right of reimbursement is cumulative with and not exclusive of HMO’s subrogation right and HMO may choose to exercise either or both rights of recovery. The Member and the Member’s representatives further agree to:
Appears in 6 contracts
Samples: Certificate of Coverage, Certificate of Coverage, Group Agreement
Subrogation and Right of Recovery. If HMO provides health care benefits under this Certificate to a Member for injuries or illness for which another party is or may be responsible, then HMO retains the right to repayment of the full cost of all benefits provided by HMO on behalf of the Member that are associated with the injury or illness for which another party is or may be responsible. HMO’s rights of recovery apply to any recoveries made by or on behalf of the Member from the following sources, including but not limited to: payments made by a third-party tortfeasor or any insurance company on behalf of the third-party tortfeasor; any payments or awards under an uninsured or underinsured motorist coverage policy; any Workers’ Compensation or disability award or settlement; medical payments coverage under any automobile policy, premises or homeowners medical payments coverage or premises or homeowners insurance coverage; any other payments from a source intended to compensate a Member for injuries resulting from an accident or alleged negligence. The Member specifically acknowledges HMO’s right of subrogationsubrogation in writing. When HMO provides health care benefits for injuries or illnesses for which another party is or may be responsible, HMO shall be subrogated to the Member’s rights of recovery on a fair and equitable basis against any party to the extent of the full cost of all benefits provided by HMO. HMO may proceed against any party with or without the Member’s consent. The Member also specifically acknowledges HMO’s right of reimbursementreimbursement in writing. This right of reimbursement shall be done on a fair and equitable basis. HMO’s right of reimbursement attaches when HMO has provided health care benefits for injuries or illness for which another party is or may be responsible and the Member and/or the Member’s representative has recovered any amounts from another party or any party making payments on the party’s behalf. By providing any benefit under this Certificate, HMO is granted an assignment of the proceeds of any settlement, judgment or other payment received by the Member to the extent of the full cost of all benefits provided by HMO. HMO’s right of reimbursement is cumulative with and not exclusive of HMO’s subrogation right and HMO may choose to exercise either or both rights of recovery. The Member For the basis of these subrogation and reimbursement provisions, a just and equitable basis shall be defined as any factors that diminish the potential value of the Member’s representatives further agree toclaim shall likewise reduce the share in the claim HMO shall receive in recompensation for benefits paid. These factors that may diminish the potential value of the Member’s claim shall include, but are not limited to the following:
Appears in 2 contracts
Samples: Group Agreement, Group Agreement
Subrogation and Right of Recovery. If HMO provides health care benefits under this Certificate to a Member for injuries or illness for which another party is or may be responsible, then HMO retains the right to repayment of the full cost of all benefits provided by HMO on behalf of the Member that are associated with the injury or illness for which another party is or may be responsible. HMO’s rights of recovery apply to any recoveries made by or on behalf of the Member from the following sources, including but not limited to: payments made by a third-party tortfeasor or any insurance company on behalf of the third-party tortfeasor; any payments or awards under an uninsured or underinsured motorist coverage policy; any Workers’ ' Compensation or disability award or settlement; medical payments coverage under any automobile policy, premises or homeowners medical payments coverage or premises or homeowners insurance coverage; any other payments from a source intended to compensate a Member for injuries resulting from an accident or alleged negligence. The Member specifically acknowledges HMO’s right of subrogation. When HMO provides health care benefits for injuries or illnesses for which another a third party is or may be responsible, HMO shall be subrogated to the Member’s rights of recovery against any third party to the extent of the full cost of all benefits provided by HMO. HMO may proceed against any party with or without the Member’s consent. The Member also specifically acknowledges HMO’s right of reimbursement. This right of reimbursement attaches when HMO has provided health care benefits for injuries or illness for which another party is or may be responsible and the Member and/or the Member’s representative has recovered any amounts from another party or any party making payments on the party’s behalf. By providing any benefit under this Certificate, HMO is granted an assignment of the proceeds of any settlement, judgment or other payment received by the Member to the extent of the full cost of all benefits provided by HMO. HMO’s right of reimbursement is cumulative with and not exclusive of HMO’s subrogation right and HMO may choose to exercise either or both rights of recovery. The Member and the Member’s representatives further agree to:
Appears in 2 contracts
Samples: Group Agreement, Group Agreement
Subrogation and Right of Recovery. If HMO provides health care benefits under this Certificate to a Member for injuries or illness for which another party is or may be responsible, then HMO retains the right to repayment of the full cost of all benefits provided by HMO on behalf of the Member that are associated with the injury or illness for which another party is or may be responsible. HMO’s rights of recovery apply to any recoveries made by or on behalf of the Member from the following sources, as allowed by law, including but not limited to: payments made by a third-party tortfeasor or any insurance company on behalf of the third-party tortfeasor; any payments or awards under an uninsured or underinsured motorist coverage policy; any Workers’ Compensation worker’s compensation or disability award or settlement; medical payments coverage under any automobile policy, premises or homeowners medical payments coverage or premises or homeowners insurance coverage; any other payments from a source intended to compensate a Member for injuries resulting from an accident or alleged negligence. The Member specifically acknowledges HMO’s right of subrogation. When HMO provides health care benefits for injuries or illnesses for which another party is or may be responsible, HMO shall be subrogated to the Member’s rights of recovery against any party to the extent of the full cost of all benefits provided by HMO, to the fullest extent permitted by law. HMO may proceed against any party with or without the Member’s consent. The Member also specifically acknowledges HMO’s right of reimbursement. This right of reimbursement attaches attaches, to the fullest extent permitted by law, when HMO has provided health care benefits for injuries or illness for which another party is or may be responsible and the Member and/or the Member’s representative has recovered any amounts from another party or any party making payments on the party’s behalf. By providing any benefit under this Certificate, HMO is granted an assignment of the proceeds of any settlement, judgment or other payment received by the Member to the extent of the full cost of all benefits provided by HMO. HMO’s right of reimbursement is cumulative with and not exclusive of HMO’s subrogation right and HMO may choose to exercise either or both rights of recovery. The Member and the Member’s representatives further agree to:
Appears in 1 contract
Samples: Group Agreement
Subrogation and Right of Recovery. If HMO provides health care benefits under this Certificate to a Member for injuries or illness for which another party is or may be responsible, then HMO retains the right to repayment of the full cost of all benefits provided by HMO on behalf of the Member that are associated with the injury or illness for which another party is or may be responsible. HMO’s rights of recovery apply to any recoveries made by or on behalf of the Member from the following sources, as allowed by law, including but not limited to: payments made by a third-party tortfeasor or any insurance company on behalf of the third-party tortfeasor; any payments or awards under an uninsured or underinsured motorist coverage policy; any Workersworkers’ Compensation compensation or disability award or settlement; medical payments coverage under any automobile policy, premises or homeowners medical payments coverage or premises or homeowners insurance coverage; any other payments from a source intended to compensate a Member for injuries resulting from an accident or alleged negligence. The Member specifically acknowledges HMO’s right of subrogation. When HMO provides health care benefits for injuries or illnesses for which another party is or may be responsible, HMO shall be subrogated to the Member’s rights of recovery against any party to the extent of the full cost of all benefits provided by HMO. HMO may proceed against any party with or without the Member’s consent. The Member also specifically acknowledges HMO’s right of reimbursement. This right of reimbursement attaches when HMO has provided health care benefits for injuries or illness for which another party is or may be responsible and the Member and/or the Member’s representative has recovered any amounts from another party or any party making payments on the party’s behalf. By providing any benefit under this Certificate, HMO is granted an assignment of the proceeds of any settlement, judgment or other payment received by the Member to the extent of the full cost of all benefits provided by HMO. HMO’s right of reimbursement is cumulative with and not exclusive of HMO’s subrogation right and HMO may choose to exercise either or both rights of recovery. The Member and the Member’s representatives further agree to:
Appears in 1 contract
Samples: Group Agreement