Common use of Longer or Shorter Length of Coverage Clause in Contracts

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 paid under this plan. If it does, Blue Cross and Blue Shield of Montana may pay that amount to the organization that made that payment. That amount will then be treated as though it were a Benefit paid under this plan. Blue Cross and Blue Shield of Montana will not have to pay that amount again. The term "payment made" includes providing Benefits in the form of services, in which case "payment made" means the reasonable cash value of the Benefits provided in the form of services. Right of Recovery‌ If the amount of the payments made by Blue Cross and Blue Shield of Montana is more than it should have paid under this COB provision, it may recover the excess from one or more of the Members it has paid or for whom it has paid; or any other person or organization that may be responsible for the benefits or services provided for the Member. The "amount of the payments made" includes the reasonable cash value of any benefits provided in the form of services.

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 primary plan. Effect on the Benefits of This Plan‌ 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 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 Payment A payment made under another plan may include an amount that should have been paid under this plan. If it does, Blue Cross and Blue Shield of Montana may pay that amount to the organization that made that payment. That amount will then be treated as though it were a Benefit paid under this plan. Blue Cross and Blue Shield of Montana will not have to pay that amount again. The term "payment made" includes providing Benefits in the form of services, in which case "payment made" means the reasonable cash value of the Benefits provided in the form of services. Right of Recovery‌ Recovery If the amount of the payments made by Blue Cross and Blue Shield of Montana is more than it should have paid under this COB provision, it may recover the excess from one or more of the Members it has paid or for whom it has paid; or any other person or organization that may be responsible for the benefits or services provided for the Member. The "amount of the payments made" includes the reasonable cash value of any benefits provided in the form of services.

Longer or Shorter Length of Coverage. The plan that covered the person member as an employee employee, subscriber or retiree longer is the primary Primary plan and the plan that covered the person member the shorter period of time is the secondary 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 planPlan. In addition, this plan Plan will not pay more than it we would have paid had it we been the primar y primary plan. Effect on the Benefits of This Plan‌ When this plan is secondarySecondary, it may we can reduce its our 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 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 expenses under its plan that is unpaid by the primary Primary plan. The secondary Secondary plan may can then reduce its payment by the amount so that, when combined with the amount paid by the primary Primary plan, the total benefits paid or provided by all plans for the claim do not exceed the total allowable expense charges for that claim. In addition, the secondary 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 member is enrolled in two or more closed panel plans and if, for any reason, including the provision of service services 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 this COB rules section and to determine Benefits benefits payable under this plan Plan and other plans. Blue Cross and Blue Shield of Montana may obtain We can get the facts and information it needs from we need from, or provide such facts and information to give them to, other organizations or persons for the purpose of applying these COB rules this section and determining Benefits benefits payable under this Plan and other plans covering the Member a member claiming Benefitsbenefits. Blue Cross and Blue Shield of Montana We need not informtell, or get the consent of, any person to obtain such informationdo this. Each Member member claiming Benefits benefits under this Plan must provide Blue Cross and Blue Shield of Montana give us any facts it needs we need to apply those rules this section and determine Benefits benefits payable. Facility of Payment‌ A payment made under another plan may can include an amount that should have been paid under this plan. If it does, Blue Cross and Blue Shield of Montana may we can pay that amount to the organization that made that payment. That amount will then be treated as though it were a Benefit benefit paid under this plan. Blue Cross and Blue Shield of Montana We will not have to pay that amount again. The term "“payment made" ” includes providing Benefits benefits in the form of services, in which case "“payment made" ” means the reasonable cash value of the Benefits provided in the form of services. Right of Recovery‌ If the amount of the payments made by Blue Cross and Blue Shield of Montana is more than it should have paid under this COB provision, it may recover the excess from one or more of the Members it has paid or for whom it has paid; or any other person or organization that may be responsible for the benefits or services provided for the Member. The "amount of the payments made" includes the reasonable cash value of any benefits provided in the form of services.

Longer or Shorter Length of Coverage. The plan that covered the person member as an employee employee, subscriber or retiree longer is the primary Primary plan and the plan that covered the person member the shorter period of time is the secondary Secondary plan. If the preceding rules do not determine the order of benefits, the allowable Allowable expenses shall be shared equally between the plans meeting the definition of planPlan. In addition, this plan Plan will not pay more than it we would have paid had it we been the primar y primary plan. Effect on the Benefits of This Plan‌ When this plan Plan is secondarySecondary, it may we can reduce its our benefits so that the total benefits paid or provided by all plans during a plan year are not more than the total allowable Allowable expenses. In determining the amount to be paid for any claim, the secondary 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 charges under its plan that is unpaid by the primary Primary plan. The secondary Secondary plan may can then reduce its payment by the amount so that, when combined with the amount paid by the primary Primary plan, the total benefits paid or provided by all plans for the claim do not exceed the total allowable expense Allowable charges for that claim. In addition, the secondary 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 member is enrolled in two or more closed panel plans and if, for any reason, including the provision of service services 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 this COB rules section and to determine Benefits benefits payable under this plan Plan and other plans. Blue Cross and Blue Shield of Montana may obtain We can get the facts and information it needs from we need from, or provide such facts and information to give them to, other organizations or persons for the purpose of applying these COB rules this section and determining Benefits benefits payable under this Plan and other plans covering the Member a member claiming Benefitsbenefits. Blue Cross and Blue Shield of Montana We need not informtell, or get the consent of, any person to obtain such informationdo this. Each Member member claiming Benefits benefits under this Plan must provide Blue Cross and Blue Shield of Montana give us any facts it needs we need to apply those rules this section and determine Benefits benefits payable. Facility of Payment‌ A payment made under another plan may can include an amount that should have been paid under this planPlan. If it does, Blue Cross and Blue Shield of Montana may we can pay that amount to the organization that made that payment. That amount will then be treated as though it were a Benefit benefit paid under this planPlan. Blue Cross and Blue Shield of Montana We will not have to pay that amount again. The term "“payment made" ” includes providing Benefits benefits in the form of services, in which case "“payment made" ” means the reasonable cash value of the Benefits provided in the form of services. Right of Recovery‌ If the amount of the payments made by Blue Cross and Blue Shield of Montana is more than it should have paid under this COB provision, it may recover the excess from one or more of the Members it has paid or for whom it has paid; or any other person or organization that may be responsible for the benefits or services provided for the Member. The "amount of the payments made" includes the reasonable cash value of any benefits provided in the form of services.

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 primary plan. Effect on the Benefits of This Plan‌ 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 60 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 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 Payment A payment made under another plan may include an amount that should have been paid under this plan. If it does, Blue Cross and Blue Shield of Montana may pay that amount to the organization that made that payment. That amount will then be treated as though it were a Benefit paid under this plan. Blue Cross and Blue Shield of Montana will not have to pay that amount again. The term "payment made" includes providing Benefits in the form of services, in which case "payment made" means the reasonable cash value of the Benefits provided in the form of services. Right of Recovery‌ Recovery If the amount of the payments made by Blue Cross and Blue Shield of Montana is more than it should have paid under this COB provision, it may recover the excess from one or more of the Members it has paid or for whom it has paid; or any other person or organization that may be responsible for the benefits or services provided for the Member. The "amount of the payments made" includes the reasonable cash value of any benefits provided in the form of services.

Longer or Shorter Length of Coverage. The plan that covered the person Member as an employee employee, subscriber or retiree longer is the primary plan and the plan that covered the person Member the shorter period of time is the secondary plan. If the preceding rules do not determine the order of benefits, the allowable expenses Allowable Charge shall be shared equally between the plans meeting the definition of plan. In addition, this plan Plan will not pay more than it we would have paid had it we been the primar y primary plan. Effect on the Benefits of This Plan‌ When this plan Plan is secondary, it may we can reduce its our benefits so that the total benefits paid or provided by all plans during a plan year are not more than the total allowable expensesexpense. In determining the amount to be paid for any claimClaim, 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 can 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 Claim do not exceed the total allowable expense Allowable Charge for that claimClaim. In addition, the secondary plan shall credit to its plan deductible Deductible any amounts it would have credited to its deductible Deductible in the absence of other health care coverage. If a covered person Member is enrolled in two or more closed panel plans and if, for any reason, including the provision of service Services 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 Services are needed to apply these this COB rules section and to determine Benefits benefits payable under this plan Plan and other plans. Blue Cross and Blue Shield of Montana may obtain We can get the facts and information it needs from we need from, or provide such facts and information to give them to, other organizations or persons for the purpose of applying these COB rules this section and determining Benefits benefits payable under this Plan and other plans covering the a Member claiming Benefitsbenefits. Blue Cross and Blue Shield of Montana We need not informtell, or get the consent of, any person to obtain such informationdo this. Each Member claiming Benefits benefits under this Plan must provide Blue Cross and Blue Shield of Montana give us any facts it needs we need to apply those rules this section and determine Benefits benefits payable. Facility of Payment‌ A payment made under another plan may can include an amount that should have been paid under this planPlan. If it does, Blue Cross and Blue Shield of Montana may we can pay that amount to the organization that made that payment. That amount will then be treated as though it were a Benefit benefit paid under this planPlan. Blue Cross and Blue Shield of Montana We will not have to pay that amount again. The term "“payment made" ” includes providing Benefits benefits in the form of servicesServices, in which case "“payment made" ” means the reasonable cash value of the Benefits provided in the form of services. Right of Recovery‌ If the amount of the payments made by Blue Cross and Blue Shield of Montana is more than it should have paid under this COB provision, it may recover the excess from one or more of the Members it has paid or for whom it has paid; or any other person or organization that may be responsible for the benefits or services provided for the Member. The "amount of the payments made" includes the reasonable cash value of any benefits provided in the form of servicesServices.