IQVIA Benefits Handbook
SUBROGATION AND REIMBURSEMENT
Required Notification
You must notify the plan administrator within 45 days of the date of the injury or the date you gave notice of your intent to pursue or investigate a claim to recover damages. Examples of reimbursements include uninsured motorist coverage, personal umbrella coverage, no-fault automobile coverage and homeowner's insurance.
The IQVIA Health Care Plan provides benefits in case of accidental injury or illness such as coverage for medical treatment of your illness or injury. Under this plan, if you receive benefits from other sources because of the accidental injury or illness, the IQVIA plan may be entitled to some or all of the amounts you receive because of the accident, under two legal rights—subrogation and reimbursement.
  • Subrogation is a legal right the plan can assert to recover the benefits it pays for accidental injuries or illnesses. The plan can recover these benefits from the parties who caused the accident or from their insurers and/or other insurers that provide coverage for the accidental injury or illness.
  • Reimbursement is a legal right the plan can assert to recover its benefit payments from you or your family members. There is a duty to reimburse the plan when a settlement or payment arising out of an accidental injury or illness has been made without providing for payment back to the plan.
For example, assume that John is in an auto accident and receives medical treatment for his injuries. John participates in one of the IQVIA medical options, so his treatment is covered by that option and he receives benefits from the option. If John later receives a settlement from the driver of the other car involved in the accident, the IQVIA Medical Plan is entitled to be repaid for the benefits it provided.
If you're involved in an accident and receive any benefits from the IQVIA Health Care Plan, be sure to ask the claims administrator whether you need to be aware of any subrogation or reimbursement issues.
Consequences of Subrogation and Reimbursement
Because the rights of subrogation and reimbursement can affect any recovery you may receive from a third party for your injury or illness, you should be aware that the plan has the following rights:
  • The plan has the right to receive payment on any claim against a third party, up to 100% of any services and benefits paid for your benefit, before you receive payment from that third party.
  • The plan's subrogation and reimbursement rights apply to full and partial settlements, judgments or other recoveries from the incident paid or payable to you or your representative, no matter how those proceeds are captioned or characterized.
  • The plan may enforce its subrogation and reimbursement rights even if you haven't been fully compensated for your injuries or damages, and the plan's rights will not be reduced because of your own negligence.
  • If the plan incurs attorneys' fees and costs in order to collect third-party settlement funds held by you or by your representative, the plan has the right to recover those fees and costs from you.
  • You may be required to provide information about your accident to help the plan determine who could be held liable for the injury or illness, and you must cooperate with the plan to protect its legal and equitable rights of subrogation and reimbursement.