Okay, sure, at first glance, I can see why you wouldn’t be that interested in reading any further. So let me start all over and retitle this piece with a title that is a bit sassier and more thought provoking:
IF KNOWLEDGE IS POWER, KNOWING WHAT WE DON’T KNOW IS WISDOM.
Adam Grant
“True Dat”!
Be honest, even after I wrote about bacon, if I wrote Coordination of Benefits as the title, you definitely would have just skipped over this section. Come on, be truthful….
So now that you know what this piece is about, are you going to hang in there and read it? Yes? No? Maybe? What if I promise to just cut to the chase. Fair enough, here we go….
Last week, the Plan learned of another participant who failed to adhere to the Plan’s coordination of benefits provision. This has resulted in the Plan paying $6,034.93 for claims that were another insurance carrier’s responsibility to pay.
Now, the Plan document does not look favorably on those who receive or attempt to receive Health and Benefit Plan benefits by misrepresenting their status with the Plan. In fact, the Plan demands the full and immediate remuneration of any amount paid and obligates the Fund Manager (Me) to possibly and forever terminate that participant and any dependent from the Plan and to impose criminal penalties. All of which are actions that I loathe.
Seriously, my abhorrence to taking such actions easily surpasses my dislike of continuously writing reminders and warnings on such matters. Which is pretty bad and is something the faithful readers of this section of the newsletter know that the Fund does not have to do, but to which is nevertheless provided because:
- I am not the least bit interested in seeing anyone fail. And,
- I prefer directing limited and scarce resources, specifically, money, time and energy on more productive endeavors, such as, but not limited to increasing benefits and making certain that the Plans are funded so that they can be operational and effective in the lives of its participants and their families in the immediate future and throughout the next one hundred (100) years.
But this isn’t about me, and you have to do what you have to do. With that said, the Fund is not afraid to go down that trail and hike it to its conclusion.
Getting back to that Adam Grant quote, if you are not familiar with the coordination of benefits provisions or many of the actions expressed within this piece, then it would be wise for you to check out the following sections of the Health and Benefit Plans Summary Plan Description Book:
- Coordination of Benefits
- Enrollment (Specifically, the section titled “Changes in Participant Status”)
- Participants Obligations
- Payment and Recovery
- Fraud
$6,034.93. Yes, that’s a lot of “cheddar”. The other eventualities are even more costly. The question is, could this have been avoided entirely? Of course, it could.
We are lacing up our hiking boots.