The city and the plan and trust intend that the plan shall provide each participant with payment for health care expenses incurred by the retiree participant and, if eligible, his or her spouse and his or her dependents, as provided for in the contract(s). The city and the plan and trust do not intend that payment under the plan shall exceed the amount of the expenses incurred. For this reason, the plan coordinates benefits with other health care plans as provided for in the contract(s) and according to industry standards and applicable laws.
(A) Reimbursement. If an expense is paid under the plan by the trust on behalf of a retiree participant, his or her spouse or dependents, and such expense subsequently is paid from any other source, in whole or in part, the retiree participant and/or his or her spouse or dependents shall remit to the trust an amount equal to the duplicated benefits. In addition, the trust may reimburse any other health care plan, person or entity that has paid an expense on behalf of a retiree participant, spouse or dependent, which expense was payable under the plan. In such event, the plan and the insurance carrier shall be relieved of all further responsibility with respect to that expense.
(B) Subrogation. In the event any payment is made by the trust under the plan, the plan and the trust shall be subrogated and shall succeed to the rights of any retiree participant, his or her spouse and/or dependents against any other plan, person or entity for recovery of health care expenses for which such other plan, person or entity legally is liable. All amounts so recovered, by settlement, judgment or otherwise, shall be paid to the trust. Retiree participants, their spouses and dependents shall furnish such information, execute and deliver such assignments, documents or other instruments, and take whatever steps are necessary to secure the rights of the plan. Retiree participants, their spouses and dependents shall take no action to prejudice the rights and interests of the plan hereunder.
(C) Effect of exclusions. The provisions of this section shall not be construed to create any independent right to payment of any benefit under this plan. Any exclusion or limitation contained in the plan and/or contract shall supersede any provision of this section regarding coordination of benefits.
(Ord. 08-03, passed 9-4-2008)