Order of Benefit Determination Rules definition

Order of Benefit Determination Rules determine whether This plan is a Primary plan or Secondary plan when the person has health care coverage under more than one Plan. When This plan is primary, it determines payment for its benefits first before those of any other Plan without considering any other Plan’s benefits. When This plan is secondary, it 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.
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Examples of Order of Benefit Determination Rules in a sentence

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

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

  • 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.

  • Order of Benefit Determination Rules When an Insured is covered by two or more health care plans or policies, the rules for determining the order of benefits follows: • If a Plan does not have a Coordination of Benefits provision, it will always be the Primary Plan.

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

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

  • If the Other Plan does not contain provisions establishing the Order of Benefit Determination Rules, the benefits under the Other Plan will be determined first.

Related to Order of Benefit Determination Rules

  • Adverse Benefit Determination means any of the following:

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

  • 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;

  • 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.

  • 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.

  • 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.

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

  • Dissent Procedures has the meaning set out in Section 3.1;

  • 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.).

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

  • 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.

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

  • 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.

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

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

  • Mediation Rules As defined in Section 2.03(h)(i).

  • Normal Retirement Benefit means the benefit described in Section 2.1.

  • Retirement Benefits means benefits paid by reference to reaching, or the expectation of reaching, retirement or, where they are supplementary to those benefits and provided on an ancillary basis, in the form of payments on death, disability, or cessation of employment or in the form of support payments or services in case of sickness, indigence or death. In order to facilitate financial security in retirement, these benefits may take the form of payments for life, payments made for a temporary period, a lump sum, or any combination thereof;

  • 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;

  • Event Determination Date means either:

  • Supplemental Retirement Benefit means the benefit determined under Article V of this Plan.

  • UNCITRAL Arbitration Rules means the arbitration rules of the United Nations Commission on International Trade Law.

  • Arbitration Rules means the AAA’s Commercial Arbitration Rules and Mediation Procedures.

  • TIA Applicability Determination As defined in Section 12.12.

  • SOFR Determination Time means 3:00 p.m. (New York time) on the U.S. Government Securities Business Day, at which time Compounded SOFR is published on the FRBNY’s Website.