What is my obligation as the beneficiary of an employee healthcare plan?



Unlike the governmental health plans, the language contained within your employee health plan or policy determines any obligation you may have under that plan. You should have a copy of this document, as your employer must provide it to you under federal law. If you cannot find your copy, ask your attorney if you should request one from your employer.

Search the plan document or policy for any section entitled “Subrogation,” “Third Party Liability,” “Third Party Reimbursement,” or something similar. Oftentimes this section will follow the section on Coordination of Benefits. This section will describe what rights the employee health plan may have to impose a lien upon your settlement. It also may state what your obligations are as a participant to cooperate in the plan’s lien recovery effort. Employee health plans often will contain language allowing the plan to reduce or eliminate your medical coverage if you fail to cooperate.

Consequently, it’s important that the lien rights of your employee health plan are addressed before your settlement. If you wait until after your case settles to deal with the liens, you may lose the chance to obtain a possible reduction in the lien amount.

As soon as you have found the plan document, give your attorney a complete copy of it. Then, discuss any questions you may have concerning the plan’s language or rights.