If a third party is responsible for injuries to a plan member of the Hope Health Plan, then Hope has a contractual right to file a claim for the resulting healthcare costs against the third party. This contractual right to recovery from the third party is known as
A) Subrogation
B) Partial capitation
C) Coordination of benefits
D) Aremedy provision

Question

Quizplus · Accepted Answer

Subrogation is the contractual right for a health plan to recover healthcare costs from a third party who may be responsible for the member's injuries. This allows the health plan to recover some or all of the costs they paid out on the member's behalf, and is a common practice in many health insurance plans. Partial capitation is a payment structure where providers receive a set fee for certain services, while coordination of benefits determines which insurance plan is primary and which one is secondary when a member has coverage from multiple plans. A remedy provision refers to a specific legal provision in a contract or agreement that details what remedies are available in case of a breach or violation.

If a Third Party Is Responsible for Injuries to a Plan