or on behalf of the Covered Person which is binding on any attorney or other party who represents the Covered Person whether or not an agent of the Covered Person or of any insurance company or other financially responsible party against whom a Covered Person may have a claim provided said attorney, insurance carrier or other party has been notified by Us or Our agents; • agrees that this lien shall constitute a charge against the proceeds of any recovery and We shall be entitled to assert a security interest thereon; • agrees to hold the proceeds of any recovery in trust for Our benefit to the extent of any payment made by Us. Additional Terms • No adult Covered Person may assign any rights that the Covered Person may have to recover vision expenses from any third party or other person or entity to any Dependent child without Our prior express written consent. Our right to recover shall apply to decedents’, minors’, and incompetent or disabled persons’ settlements or recoveries. • No Covered Person shall make any settlement, which specifically reduces or excludes, or attempts to reduce or exclude, the benefits provided by the plan. • Our right of recovery shall be a prior lien against any proceeds recovered by the Covered Person. This right of recovery shall not be defeated nor reduced by the application of any so-called “Made-Whole Doctrine”, “Rimes Doctrine”, or any other such doctrine purporting to defeat Our recovery rights by allocating the proceeds exclusively to non-vision expense damages. • No Covered Person shall incur any expenses on behalf of the plan in pursuit of the plan’s rights. Specifically; no court costs, attorneys' fees, or other representatives' fees may be deducted from the plan’s recovery without Our prior express written consent. This right shall not be defeated by any so-called “Fund Doctrine”, “Common Fund Doctrine”, or “Attorney’s Fund Doctrine”. • We shall recover the full amount of benefits provided under the plan without regard to any claim of fault on the part of any Covered Person, whether under comparative negligence or otherwise. • We hereby disavow all equitable defenses in the pursuit of Our right of recovery. Our recovery rights are neither affected nor diminished by equitable defenses. • In the event that a Covered Person fails or refuses to honor his obligations under the plan. We shall be entitled to recover any costs incurred in enforcing the terms of the Policy including, but not limited to, attorney’s fees, litigation, court costs, and other expenses. We shall also be
entitled to offset the reimbursement obligation against any entitlement to future vision benefits under the Covered Person has fully complied with his reimbursement obligations, regardless of how those future vision benefits are incurred. • Any reference to state law in any other provision of this plan shall not be applicable to this provision, if the plan is governed by ERISA.By acceptance of benefits under the plan, the Covered Person agrees that a breach hereof would cause irreparable and substantial harm and that no adequate remedy at law would exist. Further, We shall be entitled to invoke such equitable remedies as may be necessary to enforce the terms of the plan, including, but not limited to, specific performance, restitution, the imposition of an equitable lien and/or constructive trust, as well as injunctive relief. • Covered Persons must assist Us in pursuing any recovery rights by providing requested information.
HCVIS-SUB0
01-24
Payment of Benefits Assignment and Payment of Benefits
You may not assign to any party, including, but not limited to, a provider of healthcare services/items, Your right to benefits under this plan, nor may You assign any administrative, statutory, or legal rights or causes of action You may have under ERISA, including, but not limited to, any right to make a claim for plan benefits, to request plan or other documents, to file appeals of denied claims or grievances, or to file lawsuits under ERISA. Any attempt to assign such rights shall be void and unenforceable under all circumstances. You may, however, authorize Us to pay any healthcare benefits under this Policy to a Participating or Non- Participating Provider . When You authorize the payment of Your healthcare benefits to a Participating or Non- Participating Provider , You authorize the payment of the entire amount of the benefits due on that claim. If a provider is overpaid because of accepting duplicate payments from You and Us, it is the provider’s responsibility to reimburse the overpayment to You. We may pay all healthcare benefits for Covered Vision Services directly to a Participating Provider without Your authorization. You may not interpret or rely upon this discrete authorization or permission to pay any healthcare benefits to a Participating or Non-Participating Provider as the authority to assign any other rights under this Policy to any party, including, but not limited to, a provider of healthcare services/items.
myCigna.com
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