WHAT IF MY HEALTH PLAN PAYS FOR MY MEDICAL EXPENSES------DO I HAVE TO REIMBURSE THEM?
Updated: Jul 11
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The law in Virginia prohibits a health insurance policy issued to a Virginian or a person employed in Virginia to subrogate the person's right to recover from a third party. This simply means that if your health insurance carrier pays for your medical expenses following an accident and you are able to settle your personal injury claim with the at fault driver's insurance carrier, you are NOT required to reimburse your health insurance carrier for the medical bills that they paid on your behalf.
ERISA is the acronym for the Employee Retirement Income Security Act of 1974. ERISA is the federal statute which regulates benefits promised by employers to their employees. In a nutshell, certain types of ERISA governed health benefit plans are able to preempt Virginia's Anti Subrogation statute, thereby permitting a particular health benefit plan to subrogate personal injury claims for the benefits paid.
It is important to:
1. Determine whether you have a plan that is governed by ERISA;
2. Obtain the Plan description and try to determine whether the Plan claims a right of subrogation;
3. Determine whether the Plan is self funded or insured.
The law often changes in this area. If you are going to handle your claim on your own it is EXTREMELY IMPORTANT to make certain that you fully understand your rights and responsibilities. Similarly, if Medicaid or Medicare has paid for your medical expenses, and you recover from the at fault driver's insurance company for a personal injury claim, then Medicaid and Medicare will both seek reimbursement for bills which they paid on your behalf.