Overpayment and underpayment of benefits
If you are covered under more than one medical plan, there is a possibility that the other plan will pay a benefit that the Plan should have paid. If this occurs, the Stryker medical plan may pay the other plan the amount owed.
If the Plan pays you more than it owes under this COB provision, you should pay the excess back promptly. Otherwise, Stryker may recover the amount in the form of salary, wages, or benefits payable under any Company-sponsored benefit plans, including this plan. The Company also reserves the right to recover any overpayment by legal action or offset payments on future eligible expenses.
If the Plan overpays a health care provider, UnitedHealthcare reserves the right to recover the excess amount, from the provider pursuant to "Refund of Overpayments," below.
If Stryker pays for benefits for expenses incurred on account of a covered member, that covered member, or any other person or organization that was paid, must make a refund to Stryker if:
- The plan's obligation to pay benefits was contingent on the expenses incurred being legally owed and paid by the covered member, but all or some of the expenses were not paid by the covered member or did not legally have to be paid by the covered member.
- All or some of the payment the Plan made exceeded the benefits under the Plan.
- All or some of the payment was made in error.
The amount that must be refunded equals the amount the Plan paid in excess of the amount that should have been paid under the Plan. If the refund is due from another person or organization, the covered member agrees to help the Plan get the refund when requested.
If the refund is due from the covered member and the covered member, does not promptly refund the full amount owed, the Plan may recover the overpayment by reallocating the overpaid amount to pay, in whole or in part, future benefits for the covered member that are payable under the Plan. If the refund is due from a person or organization other than the covered member, the Plan may recover the overpayment by reallocating the overpaid amount to pay, in whole or in part, future benefits that are payable in connection with services provided to other covered members under the Plan.
The reallocated payment amount will equal the amount of the required refund or, if less than the full amount of the required refund will be deducted from the amount of refund owed to the Plan. The Plan may have other rights in addition to the right to reallocate overpaid amounts and other enumerated rights, including the right to commence a legal action.