Common use of Plan is Secondary Clause in Contracts

Plan is Secondary. If a Medical Group Member possesses health benefits coverage through another policy which is primary to PacifiCare under applicable coordination of benefits rules, including the Medicare secondary payor program, or if Medical Group Member is entitled to payment under a workers’ compensation policy or automobile insurance policy, Medical Group may pursue payment from the primary payor or workers’ compensation carrier consistent with applicable law and regulations and Medical Group’s contract, if any, with the primary payor. In such event, PacifiCare’s responsibility shall equal the amount of out-of-pocket expenses (i.e., Copayments, coinsurance, and deductibles) that Medical Group Member would incur in the absence of PacifiCare’s secondary coverage, minus the ISL Deductible and ISL Coinsurance.

Plan is Secondary. If a Medical Group Member possesses health benefits coverage through another policy which is primary to PacifiCare under applicable coordination of benefits rules, including the Medicare secondary payor program, or if Medical Group Member is entitled to payment under a workers’ compensation policy or automobile insurance policy, Medical Group may pursue payment from the primary payor or workers’ , compensation carrier consistent with applicable law and regulations and Medical Group’s contract, if any, with the primary payor. In such event, PacifiCare’s responsibility shall equal the amount of out-of-pocket expenses (i.e., Copayments, coinsurance, and deductibles) that Medical Group Member would incur in the absence of PacifiCare’s secondary coverage, minus the ISL Deductible and ISL Coinsurance.

Plan is Secondary. If a Medical Group Member possesses health benefits coverage through another policy which is primary to PacifiCare under applicable coordination of benefits rules, including the Medicare secondary payor program, or if Medical Group Member is entitled to payment under a workers’ ' compensation policy or automobile insurance policy, Medical Group may pursue payment from the primary payor or workers’ ' compensation carrier consistent with applicable law and regulations and Medical Group’s 's contract, if any, with the primary payor. In such event, PacifiCare’s 's responsibility shall equal the amount of out-of-pocket expenses (i.e., Copayments, coinsurance, and deductibles) that Medical Group Member would incur in in) the absence of PacifiCare’s 's secondary coverage, minus the ISL Deductible and ISL Coinsurance.