AETNA PPO PLAN - My Benefits Portfolio - Trinity Health

4) Assisting in Plan’s Reimbursement Activities. You have an obligation to assist the Plan in obtaining
reimbursement of the total amount paid on your behalf for the benefits or expenses for Covered
Services, and to provide the Plan with any information concerning your other insurance coverage
(whether through automobile insurance, other group health program, or otherwise) and any other person
or entity (including your insurer(s)) that may be obligated to provide payments or benefits to you or for
your benefit. You are required to (a) notify the Plan Administrator within 30 days of the date when any
notice is given to any party, including an insurance company or attorney, of your intention to pursue or
investigate a claim to recover damages or obtain compensation due to Injury, Illness, or a condition
sustained by you, (b) cooperate fully in the Plan’s exercise of its rights to subrogation and
reimbursement, (c) not do anything to prejudice those rights (such as settling a claim against another
party without including the Plan as a co-payee for the total amount paid on your behalf for the benefits
or expenses for Covered Services and notifying the Plan) or to prejudice the Plan’s ability to enforce
the terms of this provision, (d) sign any document deemed by the Plan Administrator to be relevant to
protecting the Plan’s subrogation, reimbursement or other rights, and (e) provide relevant information
when requested. The term “information” includes any documents, insurance policies, police reports, or
any reasonable request by the Plan Administrator to enforce the Plan’s rights. Failure to provide
requested information may result in the termination of your coverage under the Plan or the institution
of court proceeding against you.
5) Overpayments. If a benefit payment is made to or on behalf of any person that exceeds the benefit
amount such person is entitled to receive in accordance with the terms of the Plan, this Plan has the
right:
• To require the return of the overpayment on request; or
• To reduce, by the amount of the overpayment, any future benefit payment made to or on behalf of
that person or another person in his or her family.
This provision does not affect any other right of recovery the Plan may have with respect to
overpayments.
Your failure to follow the above terms and conditions may result, at the discretion of the Plan
Administrator, in a reduction from future benefit payments available to you under the Plan of an amount
up to the aggregate amount paid on your behalf for the benefits or expenses for Covered Services that
has not been reimbursed to the Plan.
In the event that any claim is made that any part of this subrogation and reimbursement provision is
ambiguous or questions arise concerning the meaning or intent of any of its terms, the Plan Administrator
or its delegate shall have the sole authority and discretion to resolve all disputes regarding the
interpretation of this provision.
By accepting benefits (whether the payment of such benefits is made to you or made on behalf of you to
any Provider) from the Plan, you agree that any court proceeding with respect to this provision may be
brought in any court of competent jurisdiction as the Plan may elect. By accepting such benefits, you
hereby submit to each such jurisdiction, waiving whatever rights may correspond to you by reason of your
present or future domicile.
AMENDMENT OR TERMINATION OF THE PLAN
Trinity Health intends to continue this Plan indefinitely. However, certain circumstances may require that
this Plan be amended or terminated. Trinity Health expressly reserves the right to amend, modify, or
terminate this Plan at any time in its sole discretion by action of a duly Authorized Representative.
In the event that any such action results in the termination of coverage, benefits will only be paid for
claims incurred prior to the date of termination of coverage.
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