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Terms Used In 10 Guam Code Ann. § 21205

  • Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Contract: A legal written agreement that becomes binding when signed.
  • Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. Source: FDIC
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
(a) In the case of a person who is a covered beneficiary, the DPHSS shall have the right to collect from a third party payer reasonable charges for health care services incurred by the DPHSS on behalf of such person through a health facility to the extent that the person would be eligible to receive reimbursement or indemnification from the third party payer if the person were to incur such charges on the person’s own behalf. If the insurance, medical service or health plan of that payer includes a requirement for a deductible or copayment by the beneficiary of the plan, then the amount that the DPHSS may collect from the third party payer is a reasonable charge for the care provided, less the appropriate deductible or copayment amount.

(b) A covered beneficiary may not be required to pay an additional amount to the DPHSS for health care services by reason of this Section.

(c) No provision of any insurance, medical service, or health plan contract or agreement having the effect of excluding from coverage or limiting payment of charges for certain care shall operate to prevent collection by the DPHSS under Subsection (a) if that care is provided:

(1) through an approved facility;

(2) directly or indirectly by a governmental entity;

(3) to an individual who has no obligation to pay for that care or for whom no other person has a legal obligation to pay; or

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CH 2 DIVISION OF PUBLIC WELFARE

(4) by a provider with which the third party payer has no participation agreement.

(d) Under the regulations prescribed under Subsection (e), records of the facility that provided health care services to a beneficiary of an insurance, medical service, or health plan of a third party payer shall be made available for inspection and review by representatives of the payer from which collection by the DPHSS is sought.

(e) To improve the administration of this Section, the Director may prescribe regulations providing for the collection of information regarding insurance, medical service, or health plans of third party payers held by covered beneficiaries.

(f) Information obtained under this Subsection may not be disclosed for any purpose other than to carry out the purpose of this Section.

(g) Amounts collected under this Section from a third party payer or under any other provision of law from any other payer for health care services provided at or through an approved facility shall be credited to the appropriation supporting the maintenance and operation of the facility and shall not be taken into consideration in establishing the operating budget of the facility.

(h) In the case of a third party payer that is an automobile, liability insurance or no fault insurance carrier, the right of the DPHSS to collect under this Section shall extend to health care services provided to a person entitled to health care under this Act.

SOURCE: Added by P.L. 32-183:2 (Oct. 13, 2014).

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