Res 1988-077 - Laserfiche WebLink

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(2) Establish in accordance with (1) through (3) above priorities for det~rMi~ing Primary Responsibility among the Plans obligated to provide health care services or indemnity benefits; (3) Release to Ot' obtair, from any other' Plan any inf,:.rmat iorl needed to implemE~t this provision; and, (4) Recover' the val ue of Health Services r'erldered t':1 the C,:.vet'ed Persor. under this contract to the extent that such Health Services are actually provided or indemnified by any other Plan. The order of Primary Responsibility shall not apply when the Covered Person is entitled to receive health care services or be indemnified for services (a) under worker's compensation or similar law, (b) in a Hospital or faci I i ty .:.",med, ,:.pet'ated or funded by a gc,verrlmental agency, or thrl:.ugh any program of any governmental agency unless a charge is customarily mad~ In such irlstances, the Primat'y Respcmsibi Ii ty shall always rest with those persons Or' agencies providing the health care services or indemnifying the set'vices 1.!rIder (a) ,:.r (b) ab,:.ve. In n,:, case shall Health Plan be required, wheYI cat'e is pt'ovided in a Hospital .:.r faci I i ty owr,ed .:.r opet'ated by artY g,)vEt'rlmental ager"lcy! Or' when ca~'e is provided by a program ,:.f any governmental agency, t,) provide coverage beyond what the Enrollee would have been other'wise required to pay. If the other Plan does not use the above language to coordinate benefits, both Plans will coordinate benefits in accordance with the other Plan's coordinating benefits language. Subrogation Up,:,n the delivery of Health Services, clr payment for such services pursuant to this Contract, Health Plan shall be subrogated to any Covered Person's r'ights against an employer or other third party alleged to be legally responsible for bodily injury or illness to such Covered Person, to thè extent of the maximum allowable charge of the Health Services or payments p~":lvided and to the exter,'t; that compensat iorl or damages are recovered. Health Plan may at its option appropriate to preserve its rights i1cluding the right to bring suit Covered Person shall coope~ate legal rights under this provision. take such action as may be necessary and to t'ec':.vet' such c',mpensat i,)n or damages, in the name of the Covered Person. Such fully with Health Plan in protecting its Health Plan shall be entitled to the proceeds Judgement which a ~overed Person may recover against party legally responsible for any bodily injury or Health Services were covered by Health Plan. of any sett lement (jt' any employer or third illness to the extent GH-12-12