9/12/2023 0 Comments Va copay refund(J) Any integrated delivery system (IDS) plan. (I) Any physician hospital organization (PHO) plan. (H) Any exclusive provider organization (EPO) plan. (G) Any individual practice association (IPA) plan. (F) Any Health Maintenance Organization (HMO) plan, including any such plan with a point-of-service provision or option. (E) Any Multiple Employer Welfare Arrangement (MEWA). (C) Any Employee Retirement Income and Security Act ( ERISA) plan. (B) Any plan for which the beneficiary pays a premium to an issuing agent as well as any plan to which the beneficiary is entitled as a result of employment or membership in or association with an organization or group. (A) Any plan offered by an insurer, reinsurer, employer, corporation, organization, trust, organized health care group or other entity. Health-plan contract means any plan, policy, program, contract, or liability arrangement that provides compensation, coverage, or indemnification for expenses incurred by a beneficiary for medical care or services, items, products, and supplies. (B) Uninsured and underinsured coverage, in which there is a third-party tortfeasor who caused the injuries ( i.e., benefits are not paid on a no-fault basis), but the insured party is not the tortfeasor. (A) Circumstances in which liability benefits are paid to an injured party only when the insured party's tortious acts are the cause of the injuries and For the purposes of this section:Īutomobile liability insurance means insurance against legal liability for health and medical expenses resulting from personal injuries arising from operation of a motor vehicle. VA's right to recover or collect is limited to the extent that the beneficiary or a nongovernment provider of care or services would be eligible to receive reimbursement or indemnification from the third-party payer if the beneficiary were to incur the costs on the beneficiary's own behalf. VA has the right to recover or collect reasonable charges from a third-party payer for medical care and services provided for a nonservice-connected disability in or through any VA facility to a veteran who is also a beneficiary under the third-party payer's plan. § 17.106 VA collection rules third-party payers.
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