Right to Receive and Release Needed Information. Certain facts are needed to apply these COB rules. The Plan has the right to de cide which facts it needs. It may get needed facts from or give them to any other organization or person. The Plan need not tell, or get the consent of, any person to do this. Each person claiming benefits under this Benefit Program must give the Plan any facts it needs to pay the Claim. A payment made under another Benefit Program may include an amount that should have been paid under this Benefit Program. If it does, the Plan may pay that amount to the organization that made the payment under the other Benefit Program. That amount will then be treated as though it were a benefit paid under this Benefit Program. The Plan 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 reasonable cash value of the benefits provided in the form of services. If the amount of payments made by the Plan is more than it should have paid un der this COB provision, it may recover the excess from one or more of:
Appears in 21 contracts
Samples: Health Care Benefit Program, Health Care Benefit Program, Health Care Benefit Program
Right to Receive and Release Needed Information. Certain facts are needed to apply these COB rules. The Plan has the right to de de- cide which facts it needs. It may get needed facts from or give them to any other organization or person. The Plan need not tell, or get the consent of, any person to do this. Each person claiming benefits under this Benefit Program must give the Plan any facts it needs to pay the Claim. A payment made under another Benefit Program may include an amount that should have been paid under this Benefit Program. If it does, the Plan may pay that amount to the organization that made the payment under the other Benefit Program. That amount will then be treated as though it were a benefit paid under this Benefit Program. The Plan 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 reasonable cash value of the benefits provided in the form of services. If the amount of payments made by the Plan is more than it should have paid un un- der this COB provision, it may recover the excess from one or more of:
Appears in 5 contracts
Samples: Health Care Benefit Program, Health Care Benefit Program, Health Care Benefit Program
Right to Receive and Release Needed Information. Certain facts are needed to apply these COB rules. The Plan has the right to de cide decide which facts it needs. It may get needed facts from or give them to any other organization or person. The Plan need not tell, or get the consent of, any person to do this. Each person claiming benefits under this Benefit Program must give the Plan any facts it needs to pay the Claim. A payment made under another Benefit Program may include an amount that should have been paid under this Benefit Program. If it does, the Plan may pay that amount to the organization that made the payment under the other Benefit Program. That amount will then be treated as though it were a benefit paid under this Benefit Program. The Plan 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 reasonable cash value of the benefits provided in the form of services. If the amount of payments made by the Plan is more than it should have paid un der under this COB provision, it may recover the excess from one or more of:
Appears in 4 contracts
Samples: Health Care Benefits Agreement, Health Care Benefits Agreement, Health Care Benefits Agreement
