Service Employees 32BJ North Health Fund

Tri-State Preferred North Summary Plan Description (SPD) >> Overpayments

• If you (or your dependent or beneficiary) are overpaid for a claim, you (or your dependent or beneficiary) must return the overpayment. The Fund will have the right to recover any payments made that were based on false or fraudulent information, as well as any payments made in error. Amounts recovered may include interest, costs and attorneys’ fees. If repayment is not made, the Fund may deduct the overpayment amount from any future benefits from this Fund that you or your dependent or beneficiary would otherwise receive, or a lawsuit may be initiated to recover the overpayment.

• If payment is made on your (or a dependent’s) behalf to a hospital, doctor or other provider of health care and that payment is found to be an overpayment, the Fund will request a refund of the overpayment from the provider. If the refund is not received, the amount of the overpayment plus interest, costs and attorneys’ fees will be deducted from future benefits payable to the provider, or a lawsuit may be initiated to recover the overpayment.