Order of Benefit Determination. If any covered person is eligible for services or benefits under two or more plans, any plan without a COB provision is automatically designated as the primary plan. When all applicable plans have COB provisions, the order of benefit determination will be as follows:
Order of Benefit Determination. When there is a basis for a Claim under this Benefit Program and another Benefit Program, this Benefit Program is a Secondary Program that has its benefits deter mined after those of the other program, unless:
Order of Benefit Determination. When 2 or more Plans pay benefits, the rules for determining the order of payment are as follows:
Order of Benefit Determination. Each plan determines its order of benefits using the first of the following rules that applies:
Order of Benefit Determination. When a person who received care is covered as an employee under one group Contract, and as a Dependent under another, then the employee coverage pays first. – When a Dependent child is covered under two group contracts, the Contract covering the child as a Dependent of the parent whose birthday falls earliest in the Calendar Year pays first. (If one Contract does not follow the “birthday rule” provision, then the rule followed by that Contract is used to determine the order of benefits.) However, when the Dependent child’s parents are separated or divorced, the following rules apply: o If the parent with custody of the child has not remarried, the coverage of the parent with custody pays first. o When a divorced parent with custody has remarried, the coverage of the parent with custody pays first and the stepparent’s coverage pays second before the coverage of the parent who does not have custody. o Regardless of which parent has custody, whenever a court decree specifies the parent who is financially responsible for the child’s health care expenses, the coverage of that parent pays first. – When none of the above circumstances applies, the coverage you have had for the longest time pays first, except that a Contract which covers you as a laid-off or retired employee or as a Dependent of such person pays after a Contract which covers you as other than a laid-off or retired employee or Dependent of such person. – When the Plan requests information from another carrier to determine the extent or order of your benefits under an Other Contract, and such information is not furnished after a reasonable time, then the Plan shall: o Assume the Other Contract is required to determine its benefits first; o Assume the benefits of the Other Contract are identical to the Benefits of this coverage and pay its Benefits accordingly. Once the Plan receives the necessary information to determine your benefits under the Other Contract and to establish the order of the benefit determination under the rules listed above, prior payments under this coverage will be adjusted accordingly (if the above rules require it). – If the other carrier reduces your benefits because of payment you received under this coverage and the above rules do not allow such reduction, then the Plan will advance the remainder of its full Benefits under this coverage as if your Benefits had been determined in absence of an Other Contract. However, the Plan shall be subrogated to all of your rights under ...
Order of Benefit Determination. When this is the Primary Plan, We will pay Benefits as if there were no other Plans.
Order of Benefit Determination. When a claim is made, the primary plan pays its benefits without regard to any other plans. The secondary plan adjusts its benefits so that the total benefits available will not exceed the Allowable Expense. No plan pays more that it would without the Coordination of Benefits Provision. A Plan without a Coordination of Benefits provision is always the Primary Plan. If all plans have such a provision:
Order of Benefit Determination. DEFINITIONS THIRD PARTY LIABILITY . LEGAL ACTION ........... PURPOSE OF THIS BOOKLET BASIC ACCIDENT INSURANCE MacMillan Eastern Operations Group Life Health Insurance Policy Division: Weyerhaeuser Union Employees The following outlines the benefits available from November Please check your group certificate for the coverage applicable to you.
Order of Benefit Determination. If a person is eligible to receive a benefit under this agreement and the same or similar benefit under any other contract, policy or plan, pay- ment of benefits shall be decided in the following manner: if another plan does not contain a coordination of benefits provi- sion, the benefits of such plan shall be deemed payable prior to the application of benefits under this agreement;
Order of Benefit Determination. If a person is covered under this Plan and under one or more Other Plans, the rules set forth below apply. The plan that pays first does so without regard to coverage under Other Plans. The plan that pays secondary does so with regard to, or in coordination with the allowed amounts and inclusions of coverage in excess of the Primary Plan.
