Coordination of Benefits and Subrogation Sample Clauses

Coordination of Benefits and Subrogation. IPA and HMO shall establish and implement a system for coordination of benefits and subrogation, in accordance with those rules established under the HMO's policies and procedures and applicable federal and state laws. If known to IPA, IPA shall identify and inform HMO of Members for whom coordination of benefits and subrogation opportunities exist. HMO hereby authorizes IPA to seek payment, on a fee-for service basis or otherwise, from any insurance carrier, organization, or government agency which is primarily responsible for the payment or provision of medical services provided by IPA under this Agreement which can be recovered by reason of coordination of benefits, motor vehicle injury, worker's compensation, temporary disability, occupational disease, or similar exclusionary or limiting provisions, to the extent authorized by the applicable and not otherwise prohibited by law.
Sample 1Sample 2
AutoNDA by SimpleDocs
Coordination of Benefits and Subrogation. Professional Provider agrees to and shall cause Practitioners to cooperate with Highmark’s coordination of benefits efforts consistent with a Member’s Plan Document and the Administrative Requirements. Professional Provider shall make efforts to collect and provide to Highmark other payor information as requested under established Highmark billing requirements. Professional Provider further agrees to and shall cause Practitioners to cooperate with Highmark or Health Plan in efforts to pursue subrogation claims against others where a person or entity other than Highmark or Health Plan has primary responsibility for payment.
Sample 1
Coordination of Benefits and Subrogation. Pharmacy Benefit Manager will perform and bear the cost of any and all services and activities necessary to perform the services described under this Agreement. If the State or a third-party administrator notifies Pharmacy Benefit Manager that a Member has a primary insurer other than the Employee Plan, then Pharmacy Benefit Manager will pay Claims for such Member as a secondary payor other than as a primary payor. Pharmacy Benefit Manager does not assume responsibility for establishing coordination of benefits filing orders for subsequent coverages, nor responsibility for coordination of benefits investigational efforts, subrogation, or coordination with Worker’s Compensation. In addition, Pharmacy Benefit Manager will promptly provide the State, the Employee Plans, and their respective agents with such information as may be reasonably requested to pursue subrogation or reimbursement of Claims processed by Pharmacy Benefit Manager under this Agreement.
Sample 1
Coordination of Benefits and Subrogation. The IPA shall cause IPA Physicians to cooperate with coordination of benefits and subrogation policies and procedures established by MedServ or Physicians Care. Physicians Care shall not make any payment in excess of the amount Physicians Care would be obligated to make as if the primary payor. If Physicians Care pays as the primary payor and subsequently determines that another party is liable to make payments as primary payor, the IPA Physician agrees to remit to Physicians Care any excess payment. Physicians Care may set off against payments otherwise due the IPA Physician the amount of such excess payment. 14.
Sample 1
Coordination of Benefits and Subrogation. Physicians Care shall be entitled to any amount Physicians Care collects from other insurers on account of IPA Services provided to Member Patients by IPA Physicians. The IPA shall cause IPA Physicians to cooperate with Physicians Care's coordination of benefits and subrogation policies and procedures.
Sample 1
Coordination of Benefits and Subrogation. ‌ Introduction‌ This Coordination of Benefits (COB) provision applies when you or your covered dependents have healthcare coverage under more than one plan. This plan follows the COB rules of payment issued by the Rhode Island Office of the Health Insurance Commissioner (OHIC) in Regulation 48, and the National Association of Insurance Commissioners (NAIC). From time to time these rules may change before a revised agreement can be provided. The most current COB regulations in effect at the time of coordination are used to determine the benefits available to you. When this provision applies, the order of benefit determination rules described below will determine whether we pay benefits before or after the benefits of another plan.
Sample 1
Coordination of Benefits and Subrogation. Provider shall request information from Members regarding other payers which may be primarily responsible for Member’s Covered Services. Provider shall comply with Plan’s coordination of benefits rules. If Provider has or receives information on the identity of a responsible party for coordination of benefits, Provider must immediately provide that information to Plan. Provider shall pursue payment from other responsible payers and shall bill Plan only for Covered Services not payable by the primary payer. All payment amounts received from other primary payers for Covered Services shall be promptly credited against or deducted from billable amounts otherwise payable under this Agreement. Payments by Plan as a secondary payer, when combined with payments received by Provider from all other payers, shall not exceed the amount which would otherwise be payable by Plan as primary payer under this Agreement.
Sample 1
AutoNDA by SimpleDocs
Coordination of Benefits and Subrogation 
Sample 1Sample 2Sample 3See All (191)

Related to Coordination of Benefits and Subrogation

  • Coordination of Benefits The coordination of benefits (COB) provision applies when a Member has health care coverage under more than one plan. Plan is defined below. The order of benefit determination rules govern the order in which each plan will pay a claim for benefits. The plan that pays first is called the primary plan. The primary plan must pay benefits according to its policy terms without regard to the possibility that another plan may cover some expenses. The plan that pays after the primary plan is the secondary plan. In no event will a secondary plan be required to pay an amount in excess of its maximum benefit plus accrued savings. If the Member is covered by more than one health benefit plan, and the Member does not know which is the primary plan, the Member or the Member’s provider should contact any one of the health plans to verify which plan is primary. The health plan the Member contacts is responsible for working with the other plan to determine which is primary and will let the Member know within 30 calendar days. All health plans have timely claim filing requirements. If the Member or the Member’s provider fails to submit the Member’s claim to a secondary health plan within that plan’s claim filing time limit, the plan can deny the claim. If the Member experiences delays in the processing of the claim by the primary health plan, the Member or the Member’s provider will need to submit the claim to the secondary health plan within its claim filing time limit to prevent a denial of the claim. If the Member is covered by more than one health benefit plan, the Member or the Member’s provider should file all the Member’s claims with each plan at the same time. If Medicare is the Member’s primary plan, Medicare may submit the Member’s claims to the Member’s secondary carrier.

  • Termination of Benefits Except as provided in Section 2 above or as may be required by law, Executive’s participation in all employee benefit (pension and welfare) and compensation plans of the Company shall cease as of the Termination Date. Nothing contained herein shall limit or otherwise impair Executive’s right to receive pension or similar benefit payments that are vested as of the Termination Date under any applicable tax-qualified pension or other plans, pursuant to the terms of the applicable plan.

  • Limitation of Benefits (a) Anything in this Agreement to the contrary notwithstanding, in the event it shall be determined that any benefit, payment or distribution by the Company to or for the benefit of the Executive (whether payable or distributable pursuant to the terms of this Agreement or otherwise) (a "Payment") would, if paid, be subject to the excise tax imposed by Section 4999 of the Code (the "Excise Tax"), then the Payment shall be reduced to the extent necessary to avoid the imposition of the Excise Tax. The Executive may select the Payments to be limited or reduced.

  • Payment of Benefits a) In computing the amount of disability benefits, disability will be considered as starting from the first day of disability; however, an employee must be certified by a medical practitioner for the disability within the first three days of disability. In the event that the employee is not certified within the first three days, disability will be considered as starting two complete days prior to the day that the employee is actually certified by a medical practitioner.

  • Distribution of Benefits Members of this unit with at least one year of the service to the District may apply for a number of days consistent with a one-for-one match of their individual sick leave accumulation as of the end of the previous contract year brought forward to the year of the onset of disability. The combined benefit of accumulated personal sick leave and disability bank leave may not exceed one hundred-eighty days and may carry over from one contract year to another. Employees with less than one full year of service in the District will not be require to contribute one of their individual accumulated sick leave days to the disability bank. The Board reviews the right to request re-application and documentation from anyone requesting more than forty (40) days from the pool. Any benefits will be minus other insurance coverage (i.e. worker’s compensation, social security, etc.).

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!