HSA Note Clause Samples

HSA Note. If you are entitled to and/or enrolled in Medicare, then you may not be eligible to contribute to a Health Savings Account (HSA). Please contact your HSA administrator or financial institution for further information.  The Covered Benefits under this Agreement will be available to you if you are injured by the act or omission of another person, firm, operation or entity. If you receive Covered Benefits under this Agreement for treatment of such injuries, we will be subrogated to your rights or the Personal Representative of a deceased Member, or Dependent Member, to the extent of all such payments made by us for such benefits. This means that if we provide or pay Covered Benefits, you must repay us the amounts recovered for all such payments made by us in any lawsuit, settlement, or by any other means. This rule applies to any and all monies you may receive from any third party or insurer, or from any uninsured or underinsured motorist insurance benefits, as well as from any other person, organization or entity.  By way of illustration only, our right of subrogation includes, but is not limited to, the right to be repaid when you recover money for personal injury sustained in a car accident. The subrogation right applies whether you recover directly from the wrongdoer or from the wrongdoer’s insurer, or from your uninsured motorist insurance coverage. You agree to sign and deliver to us such documents and papers as may be necessary to protect our subrogation right. You also agree to keep us advised of:  Any claims or lawsuits made against any person, firm or entity responsible for any injuries for which we have paid Covered Benefits.  Any claim or lawsuit against any insurance company, or uninsured or underinsured motorist insurance carrier.  Settlement of a legal claim or controversy without prior notice to us is a violation of this Agreement. In the event you fail to cooperate with us or take any action, through agents or otherwise, to interfere with the exercise of our subrogation right, we may recover our Covered Benefit payments from you.  When reasonable collection costs and reasonable legal expenses have been incurred in recovering sums which benefit both you and us, we will, upon request by you or your attorney, share such collection costs and legal expenses, in a manner that is fair and equitable, but only if we receive appropriate documentation of such collection costs and legal expenses. An individual does not fail to be eligible to contri...