Common use of Effect on the Benefits of this Contract Clause in Contracts

Effect on the Benefits of this Contract. A. When This Contract is secondary, it may reduce its benefits so that the total benefits paid or provided by all contracts during a plan year are not more than the total Allowable Expenses. In determining the amount to be paid for any Covered Dental Service, the Secondary Plan will calculate the benefits it would have paid in the absence of other health care coverage and apply that calculated amount to any Allowable Expense under its Contract that is unpaid by the Primary Contract. The Contract may then reduce its payment by the amount so that, when combined with the amount paid by the Primary Contract, the total benefits paid or provided by all contracts for the Covered Dental Service do not exceed the total Allowable Expenses for that Covered Dental Service. In addition, the Secondary Contract shall credit to its plan deductible any amounts it would have credited to its deductible in the absence of other health care coverage. B. If a covered person is enrolled in two or more Closed Panel Plans and if, for any reason, including the provision of service by a non-panel provider, benefits are not payable by one Closed Panel Plan, COB shall not apply between that Contract and other Closed Panel Plans.