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

  • 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.

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

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

  • The DCL Plan Proponents cannot have it both ways such that 1129(a)(10) is a per debtor requirement to defeat confirmation of the NPP Plan, but a per plan requirement for purposes of the DCL Plan.120 The Guarantor Non-Debtors consist of four subsidiaries of Tribune: Tribune (FN) Cable Ventures, Inc.

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

  • The benefits of This Plan: (a) will not be reduced when, under the Order of Benefit Determination Rules, This Plan determines its benefits before another Plan; but (b) may be reduced when, under the Order of Benefit Determination Rules, another Plan determines its benefits first.

  • The Order of Benefit Determination Rules determine whether This Contract is a Primary Contract or Secondary Contract when the Insured has health care coverage under more than one (1) Contract.

  • 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.

  • If this COB section applies, the Order of Benefit Determination Rules should be looked at first.

  • This section is intended to describe the Order of Benefit Determination Rules that govern the order in which each Plan will pay a Claim for Benefits.

Related to Order of Benefit Determination Rules

  • Adverse Benefit Determination means any of the following:

  • Expert Determination the process described in Paragraph 6 of Schedule 8.3 (Dispute Resolution Procedure);

  • Disability benefit recipient means a member who is receiving a disability benefit.

  • 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.

  • 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 an annual benefit equal to One Hundred Fifty Thousand Dollars and No/100 ($150,000.00) per year, payable in accordance with the terms of this Agreement. Beginning on the thirteenth month that the Normal Retirement Benefit is paid, and continuing thereafter until paid in full, the Normal Retirement Benefit shall be increased annually by three percent (3%) from the previous year’s Normal Retirement Benefit amount to account for cost of living increases.

  • Claim for Benefits means a request for a Plan benefit or benefits made by a Member in accordance with the Plan’s Appeals Procedures, including any Pre-Service Claims (requests for Prior Authorization) and Post-Service Claims (requests for benefit payment).

  • 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, in respect of the first Subsequent Reset Period, the second Business Day prior to the Second 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.

  • 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.