Order of Benefit Determination definition

Order of Benefit Determination means the procedure used to decide which plan will determine its benefits before any other plan.
Sample 1Sample 2Sample 3
Order of Benefit Determination means the procedure used to decide which plan will determine its benefits before any other plan. Each policy, contract or other arrangement for benefits or services will be treated as a separate plan. Each part of The Empire Plan that reserves the right to take the benefits or services of other plans into account to determine its benefits will be treated separately from those parts that do not.
Sample 1Sample 2Sample 3
Order of Benefit Determination means the procedure used to decide which plan will determine its benefits before any other plan. Each policy, contract or other arrangement for benefits or services will be treated as a separate plan. Each part of The Empire Plan that reserves the right to take the benefits or services of other plans into account to determine its benefits will be treated separately from those parts that do not.C. When coordination of benefits applies and The Empire Plan is secondary, payment under The Empire Plan will be reduced so that the total of all payments or benefits payable under The Empire Plan and under another plan is not more than the total allowable charge for the service you receive.D. Payments under The Empire Plan will not be reduced on account of benefits payable under another plan if the other plan has a Coordination of Benefits or similar provision with the same order of benefit determination as stated in Item E. and under that order of benefit determination, the benefits under The Empire Plan are to be determined before the benefits under the other plan.E. When more than one plan covers the person making the claim, the order of benefit payment is determined using the first of the following rules that applies:1. The benefits of the plan that covers the person as an enrollee are determined before those of other plans that cover that person as a dependent;2. When this Plan and another plan cover the same child as a dependent of different persons called “parents” and the parents are not divorced or separated (For coverage of a dependent of parents who are divorced or separated, see paragraph 3. below)
Sample 1Sample 2

Examples of Order of Benefit Determination in a sentence

  • The Order of Benefit Determination Rules govern the order in which each Contract will pay a claim for benefits.

  • If an Insured is covered by more than one Secondary Plan, the Order of Benefit Determination rules in this provision shall decide the order in which the Secondary Plan’s benefits are determined in relation to each other.

  • Order of Benefit Determination - Each Plan determines its order of benefits using the first of the following rules that apply: 1.

  • The Order of Benefit Determination Rules state whether This Plan is a Primary Plan or Secondary Plan as to another Plan covering the person.

  • The Plan that, according to the rules for the Order of Benefit Determination, pays benefits before all other Plans.

  • Contract is defined below.The Order of Benefit Determination Rules govern the order in which each Contract will pay a claim for benefits.

  • If this COB provision applies, the Order of Benefit Determination Rules should be reviewed first.

  • You will find the rules under Order of Benefit Determination Rules in this section.The Order of Benefit Determination Rules will be used to determine which plan is the primary plan.

  • The Order of Benefit Determination Rules will be used to determine which Plan is the Primary Plan.

  • This Section applies when, in accordance with the Section "Order of Benefit Determination", This Plan is a Secondary Plan as to one or more other Plans.


More Definitions of Order of Benefit Determination

Order of Benefit Determination means the order in which each Group Plan pays benefits, i.e. which plan pays first (primary); which plan pays second (secondary).
Sample 1

Related to Order of Benefit Determination

  • Adverse Benefit Determination means any of the following:

  • Expert Determination has the meaning given to it in Clause 18.3(a) (Expert Determination).

  • Final Adverse Benefit Determination means an adverse benefit determination that is upheld at the completion of a health plan issuer’s internal appeals process.

  • Claim Determination Period means a calendar year. However, it does not include any part of a year during which a person has no coverage under This Plan, or any part of a year before the date this COB provision or a similar provision takes effect.

  • Administrative merits determination means certain notices or findings of labor law violations issued by an enforcement agency following an investigation. An administrative merits determination may be final or be subject to appeal or further review. To determine whether a particular notice or finding is covered by this definition, it is necessary to consult section II.B. in the DOL Guidance.

  • Accounting Restatement Determination Date means the earliest to occur of: (a) the date the Board, a committee of the Board, or one or more of the officers of the Company authorized to take such action if Board action is not required, concludes, or reasonably should have concluded, that the Company is required to prepare an Accounting Restatement; and (b) the date a court, regulator, or other legally authorized body directs the Company to prepare an Accounting Restatement.

  • Event Determination Date means either:

  • Payment Determination Date means, with respect to any Payment Date, one (1) Business Day immediately preceding such Payment Date.

  • Benchmark Determination Date means (a) if the Benchmark is LIBOR, the LIBOR Determination Date, (b) if the Benchmark is Term SOFR, the date that is two Business Days before the first day of the applicable Accrual Period, (c) if the Benchmark is Compounded SOFR, the date that is five Business Days before the last day of the applicable Accrual Period and (d) if the Benchmark is any other rate, the date determined by the Trust according to Section 2.16 of the Indenture.

  • Eligibility Determination means an approval or denial of eligibility and a renewal or termination of eligibility as set forth in OAR 410-200-0015;¶

  • Dividend Determination Date means, for the purposes of the definition of “Dividend”, the date on which the number of Ordinary Shares or, as the case may be, amount of other property or assets, which may be issued or delivered is, or is capable of being, determined, and where determined by reference to prices or values or the like on or during a particular day or during a particular period, the Dividend Determination Date shall be deemed to be such day or the last day of such period, as the case may be;

  • Disability Benefit means the benefit set forth in Article 8.

  • Reset Determination Date means, in respect of the First Reset Period, the second Business Day prior to the First Reset Date and, in respect of each Subsequent Reset Period thereafter, the second Business Day prior to the first day of each such Subsequent Reset Period;

  • SOFR Determination Date has the meaning specified in the definition of “Daily Simple SOFR”.

  • Distribution Determination Date means, in respect of any Distribution Period, that number of business days prior thereto as is set out in the applicable Pricing Supplement or on the face of the relevant Perpetual Security;

  • Monthly Report Determination Date The meaning specified in Section 10.7(a).

  • Disability benefits means any cash payments which are payable to a covered individual for all or part of a period of disability pursuant to P.L.1948, c.110 (C.43:21-25 et al.).

  • Interest Determination Date means, with respect to a Rate of Interest and Interest Accrual Period, the date specified as such hereon or, if none is so specified, (i) the first day of such Interest Accrual Period if the Specified Currency is Sterling or (ii) the day falling two Business Days in London for the Specified Currency prior to the first day of such Interest Accrual Period if the Specified Currency is neither Sterling nor euro or (iii) the day falling two TARGET Business Days prior to the first day of such Interest Accrual Period if the Specified Currency is euro.

  • Spread Determination Date means, for the reset rate notes, any time after the Notice Date but no later than 3:00 p.m., New York City time, on the third business day prior to the related reset date.

  • Extension Determination Date means, in respect of a Series of Covered Bonds, the date falling two Business Days after the expiry of seven days from (and including) the Final Maturity Date of such Covered Bonds.

  • Final Determination Date means the following:

  • Retirement Benefit means the benefit set forth in Article 5.

  • TIA Applicability Determination As defined in Section 12.12.

  • Index Determination Date means, in relation to any Index, a date on which such Indexfalls to be determined in accordance with the Conditions;

  • Adverse determination shall have the meaning set forth in Section 19.7.

  • Reset Dividend Determination Date means, in respect of any Reset Period, the day falling three Business Days prior to the beginning of such Reset Period.