Coordination of Benefits and Third Party Liability Sample Clauses

Coordination of Benefits and Third Party Liability. Notwithstanding any provision of this Agreement to the contrary, you agree that payment to you for Covered Services (i) for which we determine that you have other than primary liability based upon the coordination of benefits provision of the State Health Plan Member’s applicable State Health Plan Member’s Health Benefit Plan or (ii) for which we have partial liability; shall not be made by us of any amount which when added to all third party benefit payments would exceed the amount you are otherwise entitled to receive as payment under this Agreement or the applicable State Health Plan Member’s Benefit Plan, or which you are otherwise required to accept as payment in full. You agree neither to xxxx nor attempt to collect any additional amounts from us or the State Health Plan Member, except for any remaining Deductible, Coinsurance, and/or Copayment amounts due according to the applicable State Health Plan Member’s Benefit Plan. You agree that payment by us in accordance with this Agreement shall fully discharge us, the State Health Plan Member, and all third parties from any and all liability for your charges, including, but not limited to, subrogation and workers’ compensation, except for any charges for Deductible, Coinsurance, and/or Copayment amounts due and owing by the State Health Plan Member. You agree not to attempt to collect any additional monies from us, the State Health Plan Member, or any third party for services rendered, including, but not limited to, subrogation and workers’ compensation, except for any charges for Deductible, Coinsurance, and/or Copayment amounts due and owing by the State Health Plan Member. Notwithstanding anything to the contrary in this Agreement, you may pursue coordination of benefits as allowed by law from any third party payor that is secondary to us.
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Coordination of Benefits and Third Party Liability. The RBHA is and shall be the payer of last resort. The Contractor and its Subcontracted Providers shall coordinate benefits, in accordance with A.R.S. (S)36-2903.G, so that costs for services otherwise payable by the RBHA are cost avoided or recovered from any other payer specified in A.A.C. R9-22-1002.A. The Contractor's claims system shall include appropriate edits for coordination of benefits and third party liability. The Contractor or Subcontracted Provider may retain any third party revenue obtained for enrolled persons if all of the following conditions exist:
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Coordination of Benefits and Third Party Liability. Contractor and Participant agree to cooperate with PUGET SOUND HEALTH PARTNERS’ coordination of benefits and duplicate coverage policies as follows: Page 16 Contractor or Participant will make best efforts to provide complete information to PUGET SOUND HEALTH PARTNERS regarding benefits available to an Enrollee from other sources including other health plan coverage. Participant will promptly refund any excess payments from PUGET SOUND HEALTH PARTNERS if, after payment is made, an Enrollee is found to be covered by another source. At PUGET SOUND HEALTH PARTNERS’ discretion, the amount to be refunded may instead be offset against any future amounts due Participant provided such offset is clearly indicated and summarized in payment report issued with payment. If Contractor or Participant has received payment from another plan or entity which pays before PUGET SOUND HEALTH PARTNERS in the coordination of benefits order of benefit determination, and that payment is equal to or greater than the contracted rates set forth in this Agreement, Contractor and Participant agree to not seek additional reimbursement from PUGET SOUND HEALTH PARTNERS or to promptly refund any amounts already paid to Contractor or Participant by PUGET SOUND HEALTH PARTNERS.
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Coordination of Benefits and Third Party Liability. SWH and Group will comply with generally accepted practices and procedures for coordination of benefits and third party liability recovery. Group shall collect information concerning duplicate coverage, workers compensation and personal injury liability at the time of admission or other Service and provide such information to SWH in a timely manner. In a case where it is determined that a third party is primarily responsible for the payment for what would otherwise be Covered Services, Group will xxxx the primary payer directly. Any payments received and the rights to such payments, from third parties responsible for payment of such services provided by Group shall be the property of Group. If SWH is secondary under Coordination of Benefits principles, SWH’s payment shall be limited to the amount, which, together with the amount remitted by the primary payer, equals the compensation due to Group under this Agreement.
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Coordination of Benefits and Third Party Liability. Provider agrees to cooperate with Payor's coordination of benefits (COB) and third party liability policies and programs. When Payor is primary, Provider shall accept their FCHN payment rate under this Agreement as payment in full from Payor, subject to Provider's right to collect co-payments, deductibles, coinsurance and payments for non-covered services from the Participant. When Payor is secondary, Provider shall first look to and promptly xxxx and take reasonable steps to collect payment from the primary carrier. Provider shall look to Payor only for any additional payment, which is in accordance with this Agreement and applicable laws regarding COB. When self-insured Benefit Plans are secondary, they may only be required to pay up to the primary’s allowable depending on the group’s Benefit Plan. The provider has the right to request a copy of the Payor’s documented COB and third party liability policies and programs. Under no circumstances shall Payor reimburse Provider any amount greater than as provided for under this Agreement. If Provider has received payment from another carrier or entity which is primary under COB, and that payment is equal to or greater than the contracted rates set forth in this Agreement, Provider agrees to not seek additional reimbursement from Payor or to promptly refund any amounts already paid to Provider by Payor.
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Related to Coordination of Benefits and Third Party Liability

  • 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.

  • Third Party Administrators for Defined Contribution Plans 2.1 The Fund may decide to make available to certain of its customers, a qualified plan program (the “Program”) pursuant to which the customers (“Employers”) may adopt certain plans of deferred compensation (“Plan or Plans”) for the benefit of the individual Plan participant (the “Plan Participant”), such Plan(s) being qualified under Section 401(a) of the Code and administered by TPAs which may be plan administrators as defined in the Employee Retirement Income Security Act of 1974, as amended.

  • Death Prior to Commencement of Benefit Payments In the event the Participant should die while actively employed by the Plan Sponsor at any time after the date of this Plan but prior to his Normal Retirement Age, the Plan Sponsor will pay the Accrued Benefit in fifteen (15) equal annual installments to the Participant's Beneficiary. The payments shall commence to be paid on the first day of the second month following the month in which the Participant dies.

  • Nonduplication of Benefits Notwithstanding any provision in this Agreement or in any other Employer benefit plan or compensatory arrangement to the contrary, but at all times subject to Section 7.4, (a) any payments due under Section 7.1, Section 7.2 or Section 7.3 shall be made not more than once, if at all, (b) payments may be due under Section 7.1, Section 7.2 or Section 7.3, but under no circumstances shall payments be made under all of or any combination of Section 7.1, Section 7.2 and Section 7.3, (c) no payments made under Sections 7.1, 7.2 and 7.3 this Agreement shall be considered compensation for purposes of any benefit plan or compensatory arrangement of Employer, and (d) Executive shall not be entitled to severance benefits from Employer other than as contemplated under this Agreement, unless such other severance benefits offset and reduce the benefits due under this Agreement on a dollar-for-dollar basis, but not below zero.

  • Termination of Benefit Plans Effective as of the day immediately preceding the Closing Date, the Company shall terminate all Company Employee Plans that are “employee benefit plans” subject to ERISA including any Company Employee Plans intended to include a Code Section 401(k) arrangement (unless Buyer provides written notice to the Company no later than three Business Days prior to the Closing Date that such 401(k) plans shall not be terminated). Unless Buyer provides such written notice to the Company, no later than three Business Days prior to the Closing Date, the Company shall provide Buyer with evidence that such Company Employee Plan(s) have been terminated (effective no later than the day immediately preceding the Closing Date) pursuant to resolutions of the Company Board. The form and substance of such resolutions shall be subject to review and approval of Buyer. The Company also shall take such other actions in furtherance of terminating such Company Employee Plan(s) as Buyer may reasonably require. In the event that termination of the Company’s 401(k) Plan would reasonably be anticipated to trigger liquidation charges, surrender charges or other fees then the Company shall take such actions as are necessary to reasonably estimate the amount of such charges and/or fees and provide such estimate in writing to Buyer no later than ten Business Days prior to the Closing Date.

  • Release Prior to Payment of Benefits Upon the occurrence of a Change in Control Termination or a Covered Termination, as applicable, and prior to Executive earning any entitlement to any severance or separation benefits under this Agreement on account of such Change in Control Termination or Covered Termination, as applicable, Executive must execute the appropriate Release, and such Release must become effective in accordance with its terms, but in no event later than the Release Deadline Date. No amount shall be paid prior to such date. Instead, on the first regularly-scheduled payroll date occurring on or after the Release Deadline Date, the Company will pay Executive the severance amount that Executive would otherwise have received on or prior to such date but for the delay in payment related to the effectiveness of the Release, with the balance of the severance amount being paid as originally scheduled. The Company may modify the Release in its discretion to comply with changes in applicable law at any time prior to Executive’s execution of such Release. Such Release shall specifically relate to all of Executive’s rights and claims in existence at the time of such execution and shall confirm Executive’s obligations under the Confidentiality Agreement and any similar obligations under applicable law. It is understood that, as specified in the applicable Release, Executive has a certain number of calendar days to consider whether to execute such Release. If Executive does not execute and deliver such Release within the applicable period, no benefits shall be provided or payable under this Agreement, and Executive shall have no further rights, title or interests in or to any severance benefits or payments pursuant to this Agreement. It is further understood that if Executive is age 40 or older at the time of a Change in Control Termination or a Covered Termination, as applicable, Executive may revoke the applicable Release within seven (7) calendar days after its execution by Executive. If Executive revokes such Release within such subsequent seven (7) day period, no benefits shall be provided or payable under this Agreement pursuant to such Change in Control Termination or Covered Termination, as applicable.

  • Benefit of Agreement; Third-Party Beneficiaries This Agreement is for the benefit of and will be binding on the parties and their permitted successors and assigns. The Owner Trustee and the Indenture Trustee, for the benefit of the Noteholders, will be third-party beneficiaries of this Agreement and may enforce this Agreement against the Asset Representations Reviewer and the Servicer. No other Person will have any right or obligation under this Agreement.

  • 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.

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