(A) Intent. The city intends that this chapter shall provide each retiree with payment for health care expenses incurred by the retiree, as provided in this chapter and/or insurance agreement. The city does not intend that payment under this chapter shall exceed the amount of the expenses incurred. For this reason, this chapter coordinates benefits with other insurance policies according to industry standards and applicable laws. If a participant becomes eligible for Medicare, plan benefits for such participant will be adjusted to reflect Medicare as primary coverage.
(B) Reimbursement. If an expense is paid under this chapter by the Plan Administrator on behalf of a retiree and such expense subsequently is paid from any other source, in whole or in part, the retiree shall remit to this chapter an amount equal to the duplicated benefits. In addition, the Plan Administrator may reimburse any other plan, person or entity that has paid an expense on behalf of a retiree which expense was payable under this chapter. In such event, this chapter, Plan Administrator and/or the insurance carrier shall be relieved of all further responsibility with respect to that expense.
(C) Subrogation. In the event any payment is made by the fund under this chapter, this chapter shall be subrogated and shall succeed to the rights of any retiree 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 fund. Retirees shall furnish such information, execute and deliver such assignments, documents or other instruments and take whatever steps are necessary to secure the rights of this chapter. Retirees shall take no action to prejudice the rights and interests of this chapter hereunder.
(D) 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 this chapter and/or insurance agreement shall supersede any provision of this section regarding coordination of benefits.
(Ord. 886, passed 11-11-02)