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

Effect on the Benefits of this Plan. 1. When this plan is secondary, it may reduce its benefits so that the total benefits paid or provided by all plans during a plan year are not more than the total allowable expenses. In determining the amount to be paid for any claim, 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 plan that is unpaid by the Primary plan. The secondary plan may then reduce its payment by the amount so that, when combined with the amount paid by the primary plan, the total benefits paid or provided by all plans for the claim do not exceed the total allowable expense for that claim. In addition, the secondary plan shall credit to its plan Deductible any amount it would have credited to its Deductible in the absence of other health care coverage. 2. 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 plan and other closed panel plans.

Effect on the Benefits of this Plan. 1. A. When this plan This Plan is secondary, it may reduce its benefits so that the total benefits paid or provided by all plans during a plan year Plans are not more than the total allowable expensesAllowable Expenses. In determining the amount to be paid for any claim, the secondary plan 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 Allowable Expense under its plan Plan that is unpaid by the Primary planPlan. The secondary plan Secondary Plan may then reduce its payment by the amount so that, when combined with the amount paid by the primary planPrimary Plan, the total benefits paid or provided by all plans Plans for the claim do not exceed the total allowable expense Allowable Expense for that claim. In addition, the secondary plan Secondary Plan shall credit to its plan Deductible deductible any amount amounts it would have credited to its Deductible deductible in the absence of other health care coverage. 2. B. If a covered person Covered Person is enrolled in two or more closed panel plans 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 planClosed Panel Plan, COB shall not apply between that plan Plan and other closed panel plansClosed Panel Plans.