When You Are Covered by More Than One Insurer Sample Clauses

When You Are Covered by More Than One Insurer. A healthcare coverage plan is considered the primary plan and its benefits will be paid first if: • the plan does not use similar COB rules to determine coverage; or • the plan does not have a COB provision; or • The plan has similar the COB rules and is determined to be primary under the order of benefit determination rules described below. Benefits under another plan include all benefits that would be paid if claims had been initially submitted under that plan. The following factors are used to determine which plan is primary and which plan is • if you are the main subscriber or a dependent; • if you are married, which spouse was born earlier in the year; • the length of time each spouse has been covered under the plan; • if a parental custody or divorce decree applies; or • if Medicare is your other coverage then Medicare guidelines will apply. These factors make up the order of benefit determination rules, described in greater detail below:
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When You Are Covered by More Than One Insurer. Covered benefits provided under any other plan will always be paid before the benefits under our plan if that insurer does not use a similar coordination of benefits rule to determine coverage. The plan without the coordination of benefits provision will always be the primary plan. Benefits under another plan include all benefits that would be paid if claims had been submitted for them. If you are covered by more than one plan and both insurers use similar coordination of benefits rules to determine coverage, we use the following conditions to determine which plan covers you first:  whether you are the main subscriber or a dependent;  if married, whether you or your spouse was born earlier in the year;  the length of time each spouse has been covered;  if a parental custody or divorce decree applies; or  if Medicare is your other coverage. If so, then Medicare guidelines apply.
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Related to When You Are Covered by More Than One Insurer

  • When You Have More Than One Plan with BCBSRI If you are covered under more than one plan with us, you are entitled to covered benefits under both plans. If one plan has a benefit that the other(s) does not, you are entitled to coverage under the plan that has the benefit. The total payments you receive will never be more than the total allowable expense for the services you receive.

  • Qualifying Insurers For insurance to satisfy the requirements of this section, all required insurance must be issued by an insurer with an A.M. Best rating of A - or better that is approved to do business in the State of California.