Longer or Shorter Length of Coverage. The Plan that covered the person as an employee, member, policyholder, subscriber or retiree longer is the primary plan and the plan that covered the person the shorter period of time is the secondary plan.
Longer or Shorter Length of Coverage. The Health Care Plan that has covered the person as an employee, member, policyholder, subscriber, or retiree longer is the primary plan, and the Health Care Plan that has covered the person the shorter period is the secondary plan.
Longer or Shorter Length of Coverage. The Plan that covered the person as an employee, Member or Subscriber longer is primary.
Longer or Shorter Length of Coverage. The Plan that covered the Member as an employee, policyholder, Subscriber or retiree longer (as measured by the effective date of coverage) is the Primary Plan and the Plan that covered the Member the shorter period of time is the Secondary Plan. The status of the Member must be the same for all Plans for this provision to apply. The same primacy would be true if the Member is a dependent of an employee covered by the Longer or Shorter length of coverage. If the preceding rules do not determine the order of benefits, the Allowable Expense is shared equally between the Plans. In addition, This Coverage will not pay more than it would have paid had it been the Primary Plan.
Longer or Shorter Length of Coverage. The plan that covered the person as an employee or retiree longer is the primary plan and the plan that covered the person the shorter period of time is the secondary plan. If the preceding rules do not determine the order of benefits, the allowable expenses shall be shared equally between the plans meeting the definition of plan. In addition, this plan will not pay more than it would have paid had it been the primar y plan. Effect on the Benefits of This Plan 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 amounts it would have credited to its deductible in the absence of other health care coverage. 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. Right to Receive and Release Needed Information Certain facts about health care coverage and services are needed to apply these COB rules and to determine Benefits payable under this plan and other plans. Blue Cross and Blue Shield of Montana may obtain the facts and information it needs from or provide such facts and information to other organizations or persons for the purpose of applying these COB rules and determining Benefits payable under this Plan and other plans covering the Member claiming Benefits. Blue Cross and Blue Shield of Montana need not inform, or get the consent of, any person to obtain such information. Each Member claiming Benefits under this Plan must provide Blue Cross and Blue Shield of Montana any facts it needs to apply those rules and determine Benefits payable. Facility of Payment A payment made under another plan may include an amount that should have been...
Longer or Shorter Length of Coverage. The Contract that covered the Member as an employee, member, policyholder, subscriber, or retiree longer is the Primary Contract and the Contract that covered the Member the shorter period of time is the Secondary Contract.
Longer or Shorter Length of Coverage. If none of the above rules determines the order of benefits, the benefits of the Plan that has covered the individual longer will be Primary to the Plan that has covered the individual for a shorter term.
Longer or Shorter Length of Coverage. If the preceding rules do not determine the order of benefits, the plan that has covered the Member for the longer period of time is the Primary Plan and the plan that has covered the Member for the shorter period of time is the Secondary Plan.
Longer or Shorter Length of Coverage. (a) If the preceding rules do not determine the order of benefits, the plan that covered the person for the longer period of time is the primary plan and the plan that covered the person for the shorter period of time is the secondary plan.
(b) To determine the length of time a person has been covered under a plan, two successive plans shall be treated as one if the covered person was eligible under the second plan within twenty-four (24) hours after coverage under the first plan ended.
(c) The start of a new plan does not include:
(i) A change in the amount or scope of a plan’s benefits;
(ii) A change in the entity that pays, provides or administers the plan’s benefits; or
(iii) A change from one type of plan to another, such as, from a single employer plan to a multiple employer plan.
(d) The person’s length of time covered under a plan is measured from the person’s first date of coverage under that plan. If that date is not readily available for a group plan, the date the person first became a member of the group shall be used as the date from which to determine the length of time the person’s coverage under the present plan has been in force.
Longer or Shorter Length of Coverage. If the preceding rules do not determine the order or payment, the Plan that covers the Subscriber (non-dependent), retiree or dependent of either for the longer period is primary.
