A. Exclusion of Expenses
Medical expenses incurred by a Member are not eligible for sharing if such expenses are covered by insurance of any kind available to the Member (including, without limitation, worker’s compensation, fraternal benefits, health insurance or any other applicable insurance), or if a third party is responsible to pay such expenses. For example, if a Member is injured in a car accident, the Member’s automobile insurance may provide coverage and an at fault third party may be liable for the Member’s medical expenses. Under either circumstance, such medical expenses are not eligible for sharing.
B. Waiver of Expense Exclusion
CCM may, in its sole discretion, waive the foregoing exclusion as applied to specific medical expenses and determine whether such expenses are otherwise eligible for sharing under these Guidelines. However, CCM has no obligation to waive the exclusion, and specifically reserves the right to exercise or not exercise its waiver discretion. CCM may condition waiver of the exclusion on the Member entering into an agreement with CCM for subrogation, reimbursement and lien rights.
C. CCM Subrogation Right
If a Member’s specific medical expenses subject to the foregoing exclusion are paid through Medi-Share, then the Member’s rights to recover all or part of such medical expenses from an insurer or responsible third party are transferred to CCM for the benefit of the Members. The Member shall do nothing after incurring such expenses to impair such rights of recovery. At CCM’s request, the Member agrees to take all reasonable steps to assist CCM in enforcing such rights including, but not limited to, bringing suit at CCM’s expense against an insurer or responsible third party. Any amounts CCM recovers through its subrogation efforts will first be paid to reimburse CCM for its recovery expenses, and will then be paid to the Members up to the amount of medical expenses paid through Medi-Share, with any remainder to be paid to the Member.
D. Right of Reimbursement
If a Member’s specific medical expenses subject to the foregoing exclusion are paid through Medi-Share, and the Member recovers all or part of such medical expenses from an insurer or responsible third party, the Member agrees to reimburse the Members within 30 days after the Member receives payment from such insurers or responsible third parties.
E. Lien on Third Party Recoveries
If a Member’s specific medical expenses subject to the foregoing exclusion are paid through Medi-Share, and the Member recovers all or part of those medical expenses from an insurer or responsible third party, the Member hereby grants a lien to CCM for the benefit of the Members on the proceeds of any monetary recovery the Member obtains from any insurer or responsible third party, and the Member agrees to take any actions or steps necessary to secure and enforce this lien. To the extent the Member has engaged an attorney to assist in the recovery of medical expenses (such as a personal injury attorney), the Member agrees to inform the attorney of such lien.