4-06 Benefit Newsletter by jazz84

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									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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