Secondary Plan. The Plan that typically determines its benefits after those of another Plan and may reduce the benefits it pays so that all Plan benefits do not exceed 100% of the total Allowable Expense deemed customary and reasonable by Keystone. Covered Service: A service or supply specified in This Coverage for which benefits will be provided when rendered by a Provider to the extent that such item is not covered completely under the Other Plan. When benefits are provided in the form of services, the reasonable cash value of each service shall be deemed the benefit. Keystone will not be required to determine the existence of any Other Plan, or amount of benefits payable under any Other Plan, except This Coverage. The payment of benefits under This Coverage shall be affected by the benefits that would be payable under Other Plans only to the extent that Keystone is furnished with information regarding Other Plans by the Member or Subscriber or any other organization or person. Allowable Expense: Allowable expense is a health care expense, including Deductibles, Coinsurance, and Copayments, that is covered at least in part by any Plan covering the Member. When a Plan provides benefits in the form of services, the reasonable cash value of each service will be considered an Allowable Expense and a benefit paid. An expense that is not covered by any Plan covering the Member is not an Allowable Expense. In addition, any expense that a Provider by law or in accordance with a contractual agreement is prohibited from charging a Member is not an Allowable Expense. Examples of expenses that are not Allowable Expenses include, but are not limited to: The difference between the cost of a semi-private Hospital room and a private Hospital room, unless one of the Plans provides coverage for private Hospital room expenses. Any amount in excess of the highest reimbursement amount for a specific benefit when two (2) or more Plans that calculate benefit payments on the basis of usual and customary fees or relative value schedule reimbursement methodology or other similar reimbursement methodology cover the Member. Any amount in excess of the highest of the negotiated fees when two (2) or more Plans that provide benefits or services on the basis of negotiated fees cover the Member. If the Member is covered by one Plan that calculates its benefits or services on the basis of usual and customary fees or relative value schedule reimbursement methodology or other similar reimbursement...
Secondary Plan. The Plan that pays after the Primary Plan is the Secondary Plan. The Secondary Plan may reduce the benefits it pays so that payments from all Plans do not exceed 100% of the total Allowable Expense. Allowable Expense is defined below.
Secondary Plan. In addition to the above-described Health Insurance Contribution Payment, employees who elect secondary coverage or any other plan voluntarily offered by the City shall pay the excess cost, if any, of the secondary or other such coverage over the primary coverage, provided however, those employees who are subscribing to Blue Cross Classic as of July 1, 2000, shall be able to continue to receive Classic Blue as their Primary Health Care Coverage with no additional cost or co-pay to them. All other employees, including new employees hired on, or after, July 1, 2000, shall not be eligible to receive Classic Blue as their Primary Health Care coverage, but shall only be able to select Classic Blue as their Secondary Health Care coverage. Furthermore, employees who currently are able to keep Classic Blue as their Primary Health Care coverage, but who in the future decide to change to Healthmate Coast to Coast, shall not be eligible to change back to Classic Blue as Primary Health Care coverage but shall only be able to select Classic Blue as their Secondary Health Care coverage. Notwithstanding the above, any employee who retires shall be eligible to select Blue Cross Classic Blue at the time of his/her retirement for his/her “retiree health care coverage” with no additional cost or co-pay to him/her, to the extent Classic Blue is available from Blue Cross at the time.
Secondary Plan. The plan that determines its benefits after those of the other plan (primary plan). Benefits may be reduced because of the other plan’s (primary plan) benefits. Plan – This document including all schedules and all riders thereto, providing dental care benefits to which this COB provision applies, and which may be reduced as a result of the benefits of other dental plans. COB Determination Rules The fair value of services provided by Blue Cross will be considered to be the amount of benefits paid by us. We will be fully discharged from liability to the extent of such payment under this provision.
Secondary Plan. The Plan that will determine its benefits after those of another Plan and may reduce the benefits so that all Plan benefits do not exceed 100% of the total Allowable Expense.
Secondary Plan. (Secondary) means a plan that is not a primary plan.
Secondary Plan. A Plan that determines and may reduce its benefits after taking into consideration the benefits provided or paid by the Primary Plan. A Secondary Plan may also recover the Reasonable Cash Value of any services it provided to you from the Primary Plan. Allowable Expense The amount of charges considered for payment under the plan for a Covered Service prior to any reductions due to coinsurance, copayment or deductible amounts. If the Healthplan contracts with an entity to arrange for the provision of SAMPLE DOCUMENT Covered Services through that entity's contracted network of health care providers, the amount that the Healthplan has agreed to pay that entity is the allowable amount used to determine your coinsurance or deductible payments. If the Plan provides benefits in the form of services, the Reasonable Cash Value of each service is the Allowable Expense and is a paid benefit. Examples of expenses or services that are not an Allowable Expense include, but are not limited to the following:
Secondary Plan. A Plan that determines, and may reduce its benefits after taking into consideration, the benefits provided or paid by the Primary Plan. A Secondary Plan may also recover the Reasonable Cash Value of any services it provided to you. Allowable Expense A necessary, reasonable and customary service or expense, including deductibles, coinsurance or copayments that are covered in full or in part by any Plan covering you. When a Plan provides benefits in the form of services, the Reasonable Cash Value of each service is the Allowable Expense and is a paid benefit. SAMPLE DOCUMENT Examples of expenses or services that are not Allowable Expenses include, but are not limited to the following:
