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Answers to Frequently Asked THIRD PARTY SUBROGATION Questions

  1. Why do I need to notify the Health Plan if my family or I are in any type of incident or accident relating to a third party?

    Notifying the Plan Office enables us to proceed with the processing of all related claims* in a timely manner. Also, the Plan can begin compiling a "Summary of Related Paid Claims," a tool used to negotiate a settlement of your claim against the third party. This Summary is required to proceed with the third party claims and to fully reimburse the Plan.



  2. Why did I receive a set of Subrogation documents?

    The Health Plan received a claim (or claims) indicating services rendered related to an injury or illness, possibly as a result of a type of accident or incident in which a third party is involved who may be responsible.



  3. Why do I need to fill out the subrogation documents and mail them back in? Why can’t I just tell you about it over the phone?

    The Health Plan must have your information in writing to insure that information is accurate and complete. In addition, the participant’s signature is required in order for us to proceed with the processing of related claims.*



  4. Why would I inform the Health Plan if the Third Party is paying all related claims?

    You must advise the Plan of all Third Party claims in order to avoid related claims being processed by the Plan, ultimately resulting in an "Overpayment." **

    The Participant will still be responsible for any overpayments, even if you do not advise the Plan of the Third Party claim.



  5. Will the Health Plan proceed with filing a Third Party claim on my behalf since the incident or accident was not my fault?

    No. It is the Participant’s responsibility to follow-up with the third party for claims relating to the incident or accident.

* “Related claims” are claims related to your third party injury or illness.
** An "overpayment" exists when the Plan pays out more than it should due to other health carrier payments, third-party liability, incorrect billings, miscalculations, etc. If this occurs, the Participant involved will be responsible for refunding to the Plan the overpaid amount.

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