MMC Benefits Handbook
Other Important Information about the Plans
Not a Contract of Employment
These plans and the Benefits Handbook, whether on a single basis or in combination, are not a contract of employment and do not give any individual a right of employment or continued employment with Marsh McLennan.
If a Mistake Occurs
Every effort is made to pay your benefits from the plans accurately, but mistakes may occur occasionally. The Plan Administrator or Claims Administrator will make corrections that it deems appropriate, such as requiring a participant to repay an overpayment to the applicable plan, making an additional payment to an underpaid participant, adjusting future benefit payments, or other actions as necessary to correct errors or omissions. You or your family member will be notified if a plan determines that a mistake was made.
Another way that overpayments for medical benefits may be recovered would be to reduce future payments to the in-network medical provider by the amount of the overpayment. These future payments may involve a Company-sponsored plan or other employer health plans that are administered by the Company-sponsored plan's third-party administrator. Under this process, the third-party administrator would reduce future payments to in-network medical providers by the amount of the overpayment they received, and then credit the recovered amount to the plan that overpaid that provider. This recovery process will not impact the cost sharing (i.e., deductibles, coinsurance, copay) that you may be required to pay for services received from an in-network medical provider.
Right of Recovery
Payments are made in accordance with the provisions of the plans. If it is determined that payment was made for benefits that are not covered by the applicable plan, for a participant who is not covered by the applicable plan, when other insurance is primary or other similar circumstances, the plan has the right to recover the overpayment. The plan will try to collect the overpayment from the party to whom the payment was made. However, the plan reserves the right to seek overpayment from you and/or your dependents or beneficiary. Failure to comply with this request will entitle the plan to withhold benefits due to you and/or your dependents or beneficiary. The plan has the right to refer the file to an outside collection agency if internal collection efforts are unsuccessful. The plan may also bring a lawsuit to enforce its rights to recover overpayments. For medical claims, the plan will not seek overpayments, except in the case of nonpayment of premiums, fraud, or intentional misrepresentation.
Other Documents Incorporated by Reference
The terms and conditions of the plans are set forth in this Benefits Handbook, insurance policies/evidence of coverage, and benefits booklets/summaries related to the benefits under the plans. Together, these documents are incorporated by reference into the formal plan documents and constitute the written instruments under with the plans are established and maintained. An amendment to one of these documents constitutes an amendment to the plans.
This summary should be read in connection with the applicable insurance policy/evidence of coverage or benefits booklet/summary provided by the applicable insurers or Claims Administrators. Unless otherwise noted, if there is a conflict between a specific provision under the Benefits Handbook and a benefit booklet/summary or insurance policy/evidence of coverage, the Benefits Handbook controls. If the Benefits Handbook is silent, the terms of the applicable insurance policy/evidence of coverage or benefits booklet/summary controls. However, with respect to fully insured benefits, the terms of the certificate of insurance coverage or insurance policy/evidence of coverage control when describing specific benefits that are covered or insurance-related terms.