EXCLUSION FOR DUPLICATE COVERAGE Sample Clauses
EXCLUSION FOR DUPLICATE COVERAGE. In the event that an individual is both enrolled as a Subscriber under this Agreement and entitled to benefits under any of the conditions described in paragraphs 1. through 4. of this section IV.B, Blue Shield's liability for Services provided to the Subscriber for the treatment of any one (1) Sick- ness or Accidental Injury shall be reduced by the amount of benefits paid, or the reasonable value or the amount payable to the provider under the Medicare Program, whichever is less, of the Ser- vices provided without any liability for the cost thereof, for the treatment of that same Sickness or Accidental Injury as a result of the Subscriber's entitlement to such other benefits. This exclusion is applicable to:
1. Benefits provided under Title XVIII of the Social Security Act (commonly known as "Medicare").
2. Any Services, including room and board, pro- vided to the Subscriber by any federal or state governmental agency, or by any municipality, county, or other political subdivision, except that benefits provided under Chapters 7 and 8 of Part 3, Division 9 of the California Welfare and Institution Code (commonly known as Medi-Cal) or Subchapter 19 (commencing with Section 1396) of Chapter 7 of Title 42 of the United States Code are not subject to this paragraph.
3. Benefits to which the Subscriber is entitled under any workers' compensation or employ- ers' liability law, provided however that Blue Shield's rights under this paragraph will be limited to the establishment of a lien upon such other benefits up to the amount paid by Blue Shield for the treatment of the Sickness or Accidental Injury which was the basis of the Subscriber's claim for benefits under such workers' compensation or employers' liability law.
4. Benefits provided to the Subscriber for Ser- vices under any group insurance contract or health service plan agreement through any employer, labor union, corporation or associa- tion, or under any individual policy or health service plan agreement.
EXCLUSION FOR DUPLICATE COVERAGE. In the event that an individual is both enrolled as a Subscriber under this Agreement and entitled to benefits under any of the conditions described in paragraphs 1. through 4. of this section V.B, Blue Shield's liability for Services provided to the Subscriber for the treatment of any one (1) Sickness or Accidental Injury shall be reduced by the amount of benefits paid, or the reasonable value or the amount payable to the provider under the Medicare Program, whichever is less, of the Services provided without any liability for the cost thereof, for the treatment of that same Sickness or Accidental Injury as a result of the Subscriber's entitlement to such other benefits. This exclusion is applicable to:
1. Benefits provided under Title XVIII of the Social Security Act (commonly known as "Medicare").
2. Any Services, including room and board, provided to the Subscriber by any federal or state governmental agency, or by any municipality, county, or other political subdivision, except that benefits provided under Chapters 7 and 8 of Part 3, Division 9 of the California Welfare and Institution Code (commonly known as Medi-Cal) or Subchapter 19 (commencing with Section 1396) of Chapter 7 of Title 42 of the United States Code are not subject to this paragraph.