Ala. Admin. Code r. 482-1-083-.08

Current through Register Vol. 43, No. 1, October 31, 2024

Section 482-1-083-.08 - Assignment And Subrogation

(1) Any person receiving covered health care services under Section 27-21A-12(i), Code of Ala. 1975 or the Plan shall be deemed to have assigned the rights under the covered evidence of coverage to the Association to the extent of the benefits received because of the Act or the Plan. The Association may require an assignment to it of such rights by any payee, contract owner, or beneficiary as a condition precedent to the receipt of any rights or benefits conferred by the Act or the Plan upon such person. The Association shall be subrogated to these rights against the assets of any insolvent or impaired HMO.

(2) The subrogation rights of the Association under this rule shall have the same priority against the assets of the insolvent HMO as that possessed by the person entitled to receive covered health care services under the Act or the Plan.

(3) If the Association provides medical benefits or payments to an enrollee who suffers injury, disease or illness by virtue of the negligent act or omission of a third party the Association is entitled to reimbursement from such third party for the reasonable value of the benefits or payments provided, just as the insolvent HMO would be entitled to such reimbursement pursuant to Section 27-21A-30(b).

Author: Commissioner of Insurance

Ala. Admin. Code r. 482-1-083-.08

New Rule: Filed October 3, 1988; effective October 20, 1988. Filed for codification in the Alabama Administrative Code by the Department of Insurance on April 23, 2004, pursuant to the Code of Ala. 1975, § 27-7-43.

Statutory Authority:Code of Ala. 1975, §§ 27-2-17, 27-21A-19, 27-21A-12(i).