Anti-assignment of Health Plan Benefits Clause
(Summary Plan Description)


Use this Anti-assignment of Health Plan Benefits Clause in an employer health plan's summary plan description (SPD) to inform participants and beneficiaries that the plan prohibits them from assigning their rights under the plan to a third party, such as a healthcare provider. This clause includes practical guidance and drafting notes. Health plan sponsors and insurers have increasingly added anti-assignment clauses in their health plans in large part to help avert lawsuits by out-of-network healthcare providers who dispute a coverage decision, or the reimbursement rate offered by the plan or insurer for services rendered to a covered individual. When a patient seeks care from a provider that is not in the plan's network, there is no contractual relationship between the payor (plan or insurer) and the payee (doctor, hospital, or other provider). Consequently, if the provider's charged rate exceeds the amount the payor is willing to pay, the options for the provider may include simply ...