Multiple Health Plans Clause Samples
The "Multiple Health Plans" clause defines how benefits and coverage are coordinated when an individual is covered by more than one health insurance plan. Typically, this clause outlines the procedures for determining which plan is primary and which is secondary, and how claims are processed to avoid duplication of benefits. For example, if an employee is covered by both their own employer's plan and a spouse's plan, the clause will specify the order in which each plan pays. The core function of this clause is to prevent overpayment and ensure that the total benefits received do not exceed the actual costs incurred, thereby allocating responsibility and reducing the risk of insurance fraud or excessive payouts.
Multiple Health Plans. If you are enrolled as a dependent in a health plan (not Health Net) and the subscriber, during open en- rollment, chooses a different plan (such as moving from an HMO plan to a fee-for-service plan) and you do not wish to continue to be covered by it, you will not be considered a late enrollee should you decide to enroll in this SELECT Plan.