Reso 98-109 - Laserfiche WebLink

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Ronda Municipal Insurance Trust Medical Master Plan of Beneflts arises. The burden is on the applicant or participant to make complete and accurate representations to the Trust concerning questions of eligibility, coverage and services or benefits under this Plan. SECTION XVIII - PAYMENT OF BENEFITS, ASSIGNMENT Benefits provided under this Plan for a specified injury or sickness may be paid to the participant or to the service provider who has provided or paid for services or supplies for which such benefits are payable. Such benefits may be assigrled by the participant to such provider and will be paid according to the participant's designation on the claim form, but only to the extent such provider's interest shall appear; otherwise this Plan and such benefits are non-assignable. If benefits are paid prior to the receipt and acceptance by the Trust of any assignment of such benefits, the assignment shall be null and void and unenforceable against the Trust. In the event an employee or dependent dies, or is physically, mentally or otherwise incapable of making payment due to a service provider, Plan benefits may be paid directly to the service provider or to any person or institution appearing to assume responsibility for the expense, and such payment shall discharge the Trust's obligation for such expense. SECTION XIX - GRIEVANCE PROCEDURE There are situations when participants have questions about their coverage or are dissatisfied with Plan services. Such inquiries and complaints will be handled in a timely manner. In the event that a claim is denied and the participant disagrees with the denial, a re- determination may be requested in writing detailing the reasons for the disagreement, This request must be received within sixty (60) days of the initial claim denial. The Plan will respond with a written decision, within sixty (60) days from receipt of- the request. SECTION XX - SUBROGATION In the event of any payment for benefits, services or supplies provided to a participant under the Plan, the Trust, to the extent of such payment, shall be subrogated to all rights of recovery such participant has against any person or organization, and the participant, as a condition precedent to the payment for any benefits, services or supplies otherwise payable under this Plan, shall execute and deliver such instruments and papers as may be required and do whatever else is necessary to secure such rights to the Trust and shall otherwise assist and cooperate with the Trust as may be necessary in its efforts to recover such payment.