DoD NAF Health Benefits Program (HBP) Information Issue 18 April 2006 Subrogation The Rawlings Company The DoD NAF Health cident, should pay those medical Benefit Program (HBP) utilizes claims. Please be aware that the the services of The Rawlings Rawlings Company only recovers Company for the purposes of monies a third party owes to the NAF HBP; it does not recover third party. If you have already dis- subrogation. Subrogation is the monies that the third party owes regarded any information sent to right of the NAF HBP to substi- directly to you or your depend- you, don’t worry, The Rawlings tute itself as a covered plan par- ents. Company sends a total of five ques- ticipant in the recovery of medi- tionnaires to qualifying members. cal expenses incurred due to an Subrogation is an impor- Where the dollar amount of paid illness or injury for which a tant cost containment measure for claims reaches a certain level, the third party may be liable, and self-funded health programs like Rawlings Company places phone recover owed expenses. For ex- the NAF HBP. A self-funded calls to affected members. The ef- ample, if a covered member or a health plan assumes the responsi- forts of The Rawlings Company as- covered dependent were injured bility of paying all health care sists in reducing the cost of the in an accident that was the fault claims using money collected NAF HBP for both you and your of another person or party, The from premiums paid by members employer. Any savings to the Rawlings Company, on behalf each month. This means that it is health benefits program helps to of the NAF HBP, would pursue your employer who funds all sub- keep your premiums low and main- necessary action in recovering mitted claims, not Aetna. Self- tain your health benefits levels. money owed to the NAF HBP. In most cases, this involves re- funded health plans must pay all claims, regardless of whether the Additional information per- covering monies paid to you by health premiums collected are taining to the matter of subrogation the NAF HBP for medical enough to pay the claims. Medi- can be found in both the Open claims when the negligent party cal expenses from injuries caused Choice PPO and Indemnity Sum- in a third party liability situa- by a third party that are not reim- mary Plan Description or SPDs. tion, such as an automobile ac- bursed can lead to increases in This information is located in the premiums, as well as contribute to “General Information about Your future benefit reductions. There- Coverage” section under “Recovery fore, if you receive a letter or of Benefits Paid.” If you do not phone call from The Rawlings have a copy of your SPD, please Company, do not ignore it! If contact your servicing human re- you receive a letter, open it, re- sources office to obtain one. Sum- view the material, answer the mary Plan Descriptions outline questionnaire, and send it back so many details of your health benefits that your claim can be properly plan and are an important instru- pursued if money is owed from a ment in understanding its programs and policies.
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