Common use of Coordination of Benefits Clause in Contracts

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚ Employee/Dependent Rule • The plan, which covers you as an employee, pays first. • The plan, which covers you as a Dependent, pays second. ⮚ Birthday Rule for Dependent children of parents who are not separated or divorced • The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚ Dependent children of separated or divorced parents • The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • In the absence of a court order: o The plan of the parent with physical custody of the child pays first. o The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o The plan of the parent not having physical custody of the child pays third. ⮚ Active/Inactive Employee • The plan, which covers you as an active employee (or Dependent of an active employee), pays first. • The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚ Longer/Shorter Employment • In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ No Coordination Provision • In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚ We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚ We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. Coordination of Benefits (COB) applies to this Agreement when a Member has medical benefits under more than one plan. The objective of COB is to make sure the combined payments of the plans are no more than your actual medical bills. PIC coordinates benefits according to the “Standard Other Insurance Rule”. Please contact the Presbyterian Customer Service Center for additional information on this rule. Also, each plan determines the maximum allowable payment for a given service and this maximum allowable may vary by plan. For this reason, there is no guarantee that 100% of the charges will be paid even when a Member has more than one medical plan. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚ • Employee/Dependent Rule • o The plan, which covers you as an employee, pays first. • o The plan, which covers you as a Dependent, pays second. ⮚ • Birthday Rule for Dependent children of parents who are not separated or divorced • o The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • o If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚ • Dependent children of separated or divorced parents • o The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • o In the absence of a court order: o ▪ The plan of the parent with physical custody of the child pays first. o ▪ The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o ▪ The plan of the parent not having physical custody of the child pays third. ⮚ • Active/Inactive Employee • o The plan, which covers you as an active employee (or Dependent of an active employee), pays first. • o The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚ • Longer/Shorter Employment • o In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ • No Coordination Provision • o In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ • If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. • If you or your Dependents are Covered by COBRA continuation and are also Covered by another group plan, you shall receive our Covered Benefits to the extent that we will be secondary payer of all eligible charges, subject to the terms, conditions, exclusions and limitations of this Agreement. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚ • We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ • We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚ • We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, “Coordination of benefits” is the benefits provided or payable hereunder shall be reduced procedure used to the extent that benefits are available to you under such other plan, policy or program. The rules establishing the order of benefit determination between this Agreement and any other plan covering pay dental care expenses when a Member not on COBRA continuation on whose behalf a claim person is made are as follows: ⮚ Employee/Dependent Rule • The plan, which covers you as an employee, pays first. • The plan, which covers you as a Dependent, pays second. ⮚ Birthday Rule for Dependent children of parents who are not separated or divorced • The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined covered by the month and the day of birth, not the year of birth. • If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚ Dependent children of separated or divorced parents • The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • In the absence of a court order: o The plan of the parent with physical custody of the child pays first. o The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o The plan of the parent not having physical custody of the child pays third. ⮚ Active/Inactive Employee • The plan, which covers you as an active employee (or Dependent of an active employee), pays first. • The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚ Longer/Shorter Employment • In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ No Coordination Provision • In spite Company follows rules established by Florida law to decide which plan pays first and how much the other plan must pay. The objective is to make sure the combined payments of the rules listed above, the plan that has all plans are no provision regarding coordination of benefits will pay firstmore than your actual bills. ⮚ If When you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they family members are covered by another group plan in addition to this one, we will follow Florida coordination of benefit rules to determine which plan is primary and which is secondary. You must submit all bills first to the motor vehicle or home owner’s insurance policyprimary plan. The primary plan must pay its full benefits as if you had no other coverage. If the primary plan denies the claim or does not pay the full bill, you may then submit the balance to the secondary plan. Company pays for dental care only when you follow our rules and procedures. If our rules conflict with those of another plan, it may be impossible to receive benefits from both plans, and you will be forced to choose which plan to use. PLANS THAT DO NOT COORDINATE Company will pay benefits without regard to benefits paid by the following kinds of coverage. -- Individual (not group) policies or contracts unless they contain a Coordination of Benefits Provision. -- Medicaid -- Group hospital indemnity plans which pay less than $100 per day -- School accident coverage -- Some supplemental sickness and accident policies HOW COMPANY PAYS AS PRIMARY PLAN When we have provided such benefitsare primary, we shall have will pay the right to recover any benefits full benefit allowed by your contract as if you had no other coverage. HOW COMPANY PAYS AS SECONDARY PLAN When we have provided from you or from are secondary, our payments will be based on the motor vehicle or homeowner’s insurance to balance left after the extent they are available under the motor vehicle or homeowner’s insurance policyprimary plan has paid. We will pay no more than that balance. In no event shall will we pay more than we would have paid had we been primary. --We will pay only for dental care expenses that are covered by Company. --We will pay only if you have followed all of our procedural requirements, including (care obtained from or arranged by your primary care physician, precertification, etc.). --We will pay no more than the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses “allowable expenses” for the services provided under this Agreementdental care involved. For purposes If our allowable expense is lower than the primary plan’s, we will use the primary plan’s allowable expense. That may be less than the actual bill. WHICH PLAN IS PRIMARY? To decide which plan is primary, we have to consider both the coordination provisions of coordination of benefits, ⮚ We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information the other plan and which we may require. ⮚ We have the right, if we make overpayments because member of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were madefamily is involved in a claim. ⮚ We The Primary Plan will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures.determined by the first of the following which applies:

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. Coordination of Benefits (COB) applies to this Agreement when a Member has medical benefits under more than one plan. The objective of COB is to make sure the combined payments of the plans are no more than your actual medical bills. PIC coordinates benefits according to the “Standard Other Insurance Rule.” Please contact the Presbyterian Customer Service Center for additional information on this rule. Also, each plan determines the maximum allowable payment for a given service and this maximum allowable may vary by plan. For this reason, there is no guarantee that 100 percent of the charges will be paid even when a Member has more than one medical plan. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚ • Employee/Dependent Rule • o The plan, which covers you as an employee, pays first. • o The plan, which covers you as a Dependent, pays second. ⮚ • Birthday Rule for Dependent children of parents who are not separated or divorced • o The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • o If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚ • Dependent children of separated or divorced parents • o The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • o In the absence of a court order: o ▪ The plan of the parent with physical custody of the child pays first. o ▪ The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o ▪ The plan of the parent not having physical custody of the child pays third. ⮚ • Active/Inactive Employee • o The plan, which covers you as an active employee (or Dependent of an active employee), pays first. • o The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚ • Longer/Shorter Employment • o In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ • No Coordination Provision • o In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ • If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. • If you or your Dependents are Covered by COBRA continuation and are also Covered by another group plan, you shall receive our Covered Benefits to the extent that we will be secondary payer of all eligible charges, subject to the terms, conditions, exclusions and limitations of this Agreement. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚ • We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ • We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚ • We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚  Employee/Dependent Rule •  The plan, which covers you as an employee, pays first. •  The plan, which covers you as a Dependent, pays second. ⮚  Birthday Rule for Dependent children of parents who are not separated or divorced •  The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. •  If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚  Dependent children of separated or divorced parents •  The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. •  In the absence of a court order: o The plan of the parent with physical custody of the child pays first. o The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o The plan of the parent not having physical custody of the child pays third. ⮚ PHPGSAHDHPHIX_Off_2016 SERF# PBHP-130007152 - Off  Active/Inactive Employee •  The plan, which covers you as an active employee (or Dependent of an active employee), pays first. •  The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚  Longer/Shorter Employment •  In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚  No Coordination Provision •  In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚  If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy.  If you or your Dependents are Covered by COBRA continuation and are also Covered by another group plan, you shall receive our Covered Benefits to the extent that we will be secondary payer of all eligible charges, subject to the terms, conditions, exclusions and limitations of this Agreement. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚  We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚  We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚ PHPGSAHDHPHIX_Off_2016  We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. Coordination of Benefits (COB) applies to this Agreement when a Member has medical benefits under more than one plan. The objective of COB is to make sure the combined payments of the plans are no more than your actual medical bills. PHP coordinates benefits according to the “Standard Other Insurance Rule”. Please contact the Presbyterian Customer Service Center for additional information on this rule. Also, each plan determines the maximum allowable payment for a given service and this maximum allowable may vary by plan. For this reason, there is no guarantee that 100 percent (100%) of the charges will be paid even when a Member has more than one medical plan. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚ • Employee/Dependent Rule • o The plan, which covers you as an employee, pays first. • o The plan, which covers you as a Dependent, pays second. ⮚ • Birthday Rule for Dependent children of parents who are not separated or divorced • o The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • o If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚ • Dependent children of separated or divorced parents • o The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • o In the absence of a court order: o ▪ The plan of the parent with physical custody of the child pays first. o ▪ The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o ▪ The plan of the parent not having physical custody of the child pays third. ⮚ • Active/Inactive Employee • o The plan, which covers you as an active employee (or Dependent of an active employee), pays first. • o The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚ • Longer/Shorter Employment • o In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ • No Coordination Provision • o In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ • If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. • If you or your Dependents are Covered by COBRA continuation and are also Covered by another group plan, you shall receive our Covered Benefits to the extent that we will be secondary payer of all eligible charges, subject to the terms, conditions, exclusions and limitations of this Agreement. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚ • We may release, request, or obtain claim information from any individual or organization0o1rganization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ • We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚ • We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures. • To the extent necessary for PHP to meet its obligations as a secondary carrier under NM regulations, PHP shall make payments for services that are received from non- participating providers, provided outside the service area, or that are covered under the terms of the contract or evidence of coverage.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚  Employee/Dependent Rule •  The plan, which covers you as an employee, pays first. •  The plan, which covers you as a Dependent, pays second. ⮚  Birthday Rule for Dependent children of parents who are not separated or divorced •  The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. •  If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚  Dependent children of separated or divorced parents •  The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. •  In the absence of a court order: o The plan of the parent with physical custody of the child pays first. o The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o The plan of the parent not having physical custody of the child pays third. ⮚  Active/Inactive Employee •  The plan, which covers you as an active employee (or Dependent of an active employee), pays first. •  The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚  Longer/Shorter Employment •  In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ .  No Coordination Provision •  In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚  If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy.  If you or your Dependents are Covered by COBRA continuation and are also Covered by another group plan, you shall receive our Covered Benefits to the extent that we will be secondary payer of all eligible charges, subject to the terms, conditions, exclusions and limitations of this Agreement. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚  We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚  We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚  We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. Coordination of Benefits (COB) applies to this Agreement when a Member has medical benefits under more than one plan. The objective of COB is to make sure the combined payments of the plans are no more than your actual medical bills. PHP coordinates benefits according to the “Standard Other Insurance Rule.” Please contact the Presbyterian Customer Service Center for additional information on this rule. Also, each plan determines the maximum allowable payment for a given service and this maximum allowable may vary by plan. For this reason, there is no guarantee that 100% of the charges will be paid even when a Member has more than one medical plan. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚ • Employee/Dependent Rule • o The plan, which covers you as an employee, pays first. • o The plan, which covers you as a Dependent, pays second. ⮚ • Birthday Rule for Dependent children of parents who are not separated or divorced • o The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • o If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚ • Dependent children of separated or divorced parents • o The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • o In the absence of a court order: o ▪ The plan of the parent with physical custody of the child pays first. o ▪ The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o ▪ The plan of the parent not having physical custody of the child pays third. ⮚ • Active/Inactive Employee • o The plan, which covers you as an active employee (or Dependent of an active employee), pays first. • o The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚ • Longer/Shorter Employment • o In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ • No Coordination Provision • o In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ • If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. • If you or your Dependents are Covered by COBRA continuation and are also Covered by another group plan, you shall receive our Covered Benefits to the extent that we will be secondary payer of all eligible charges, subject to the terms, conditions, exclusions and limitations of this Agreement. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚ • We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ • We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚ • We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures. • To the extent necessary for PHP to meet its obligations as a secondary carrier under NM regulations, PHP shall make payments for services that are received from non- participating providers, provided outside the service area, or that are not covered under the terms of the contract or evidence of coverage.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group Most health care programs, including this Hospitalization Program contain a coordination of benefits provision. This provision is used when you, your spouse or any other your covered dependents are eligible for payment under more than one health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other care plan, policy or program. The rules establishing object of coordination of benefits is to ensure that your covered expenses will be paid, while preventing duplicate benefit payments. Here is how the order coordination of benefit determination between this Agreement and any benefits provision works:  When your other plan covering a Member coverage does not on COBRA continuation on whose behalf a claim is made are as follows: ⮚ Employee/Dependent Rule • The plan, which covers you as an employee, mention "coordination of benefits," then that coverage pays first. • The Benefits paid or payable by the other coverage will be taken into account in determining if additional benefit payments can be made under your plan.  When the person who received care is covered as an employee under one contract, which covers you and as a Dependentdependent under another, then the employee coverage pays secondfirst. ⮚ Birthday Rule for Dependent children of parents who are not separated or divorced • The plan When a dependent child is covered under two health plans, which covers the health plan covering the parent whose birthday falls earlier in the year, calendar year pays first. The planBut, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • If if both parents have the same month and day of birthbirthday, the plan that Covered the parent longer, will pay claims first. The health plan which covered the parent for a shorter period of time pays secondlonger will be the primary plan. ⮚ Dependent children of If the dependent child's parents are separated or divorced parents • divorced, the following applies: − The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • In the absence of a court order: o The plan of the parent with physical custody of the child pays first. o − The plan of the Spouse coverage of the parent with physical custody (i.e., pays first but the stepparent) 's coverage pays second. o The plan before the coverage of the parent who does not having physical custody have custody. − Regardless of which parent has custody, whenever a court decree specifies the child pays third. ⮚ Active/Inactive Employee • The planparent who is financially responsible for the child's health care expenses, which covers you as an active employee (or Dependent the coverage of an active employee), that parent pays first. •  When none of the above circumstances applies, the coverage you have had for the longest time pays first, provided that: − The plan, which covers you benefits of a health plan covering the person as an employee other than a laid- off or retired employee or as the dependent of such person shall be determined before the benefits of a plan covering the person as a retired or laid-off or retired employee (or Dependent as a dependent of a retired or such person and if − The other health plan does not have this provision regarding laid-off employee)or retired employees, pays second. ⮚ Longer/Shorter Employment • In and, as a result, plans do not agree on the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ No Coordination Provision • In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination order of benefits, ⮚ We then this rule is disregarded. If you receive more than you should have when your benefits are coordinated, you will be expected to repay any overpayment. Subrogation In general, subrogation means that if you incur health care expenses for injuries caused by another person or organization, the person or organization causing the accident may releasebe responsible for paying these expenses. For example, requestif you or one of your dependents receives Hospital Program benefits for injuries caused by another person or organization, the Fund, or obtain claim information Highmark on behalf of the Fund has the right through subrogation, to seek repayment from any individual the other person or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ We have the right, if we make overpayments because of your failure to report other coverage organization or any other reason, to recover such excess payment from any individual to whom, or applicable insurance company for whom, such payments were madebenefits already paid. ⮚ We will not be obligated to pay See Section 14 for non-Covered Services or Covered Benefits not obtained in compliance with our policies and proceduresdetails about subrogation.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. Coordination of Benefits (COB) applies to this Agreement when a Member has medical benefits under more than one plan. The objective of COB is to make sure the combined payments of the plans are no more than your actual medical bills. PHP coordinates benefits according to the “Standard Other Insurance Rule”. Please contact the Presbyterian Customer Service Center for additional information on this rule. Also, each plan determines the maximum allowable payment for a given service and this maximum allowable may vary by plan. For this reason, there is no guarantee that 100% of the charges will be paid even when a Member has more than one medical plan. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚ ➢ Employee/Dependent Rule • The plan, which covers you as an employee, pays first. • The plan, which covers you as a Dependent, pays second. ⮚ ➢ Birthday Rule for Dependent children of parents who are not separated or divorced • The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚ ➢ Dependent children of separated or divorced parents • The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • In the absence of a court order: o The plan of the parent with physical custody of the child pays first. o The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o The plan of the parent not having physical custody of the child pays third. ⮚ ➢ Active/Inactive Employee • The plan, which covers you as an active employee (or Dependent of an active employee), pays first. • The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚ ➢ Longer/Shorter Employment • In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ ➢ No Coordination Provision • In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ ➢ If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. ➢ If you or your Dependents are Covered by COBRA continuation and are also Covered by another group plan, you shall receive our Covered Benefits to the extent that we will be secondary payer of all eligible charges, subject to the terms, conditions, exclusions and limitations of this Agreement. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚ ➢ We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ ➢ We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚ ➢ We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. Coordination of Benefits (COB) applies to this Agreement when a Member has medical benefits under more than one plan. The objective of COB is to make sure the combined payments of the plans are no more than your actual medical bills. PHP coordinates benefits according to the “Standard Other Insurance Rule”. Please contact the Presbyterian Customer Service Center for additional information on this rule. Also, each plan determines the maximum allowable payment for a given service and this maximum allowable may vary by plan. For this reason, there is no guarantee that 100% of the charges will be paid even when a Member has more than one medical plan. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚ • Employee/Dependent Rule • o The plan, which covers you as an employee, pays first. • o The plan, which covers you as a Dependent, pays second. ⮚ • Birthday Rule for Dependent children of parents who are not separated or divorced • o The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • o If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚ • Dependent children of separated or divorced parents • o The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • o In the absence of a court order: o ▪ The plan of the parent with physical custody of the child pays first. o ▪ The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o ▪ The plan of the parent not having physical custody of the child pays third. ⮚ • Active/Inactive Employee • o The plan, which covers you as an active employee (or Dependent of an active employee), pays first. • o The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚ • Longer/Shorter Employment • o In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ • No Coordination Provision • o In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ • If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. • If you or your Dependents are Covered by COBRA continuation and are also Covered by another group plan, you shall receive our Covered Benefits to the extent that we will be secondary payer of all eligible charges, subject to the terms, conditions, exclusions and limitations of this Agreement. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚ • We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ • We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚ • We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures. • To the extent necessary for PHP to meet its obligations as a secondary carrier under NM regulations, PHP shall make payments for services that are received from non- participating providers, provided outside the service area, or that are not covered under the terms of the contract or evidence of coverage. Medicare‌‌ If you are enrolled in Medicare, the Covered Benefits provided by this Agreement are not designed to duplicate any benefit to which you are entitled under the Social Security Act. Covered Benefits will be coordinated in compliance with current applicable federal regulations. HSA Note: If you are entitled to and/or enrolled in Medicare, then you may not be eligible to contribute to a Health Savings Account (HSA). Please contact your HSA administrator or financial institution for further information.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. Coordination of Benefits (COB) applies to this Agreement when a Member has medical benefits under more than one plan. The objective of COB is to make sure the combined payments of the plans are no more than your actual medical bills. PHP coordinates benefits according to the “Standard Other Insurance Rule”. Please contact the Presbyterian Customer Service Center for additional information on this rule. Also, each plan determines the maximum allowable payment for a given service and this maximum allowable may vary by plan. For this reason, there is no guarantee that 100% of the charges will be paid even when a Member has more than one medical plan. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚ • Employee/Dependent Rule • o The plan, which covers you as an employee, pays first. • o The plan, which covers you as a Dependent, pays second. ⮚ • Birthday Rule for Dependent children of parents who are not separated or divorced • o The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • o If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚ • Dependent children of separated or divorced parents • o The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • o In the absence of a court order: o ▪ The plan of the parent with physical custody of the child pays first. o ▪ The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o ▪ The plan of the parent not having physical custody of the child pays third. ⮚ • Active/Inactive Employee • o The plan, which covers you as an active employee (or Dependent of an active employee), pays first. • o The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚ • Longer/Shorter Employment • o In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ • No Coordination Provision • o In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ • If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. • If you or your Dependents are Covered by COBRA continuation and are also Covered by another group plan, you shall receive our Covered Benefits to the extent that we will be secondary payer of all eligible charges, subject to the terms, conditions, exclusions and limitations of this Agreement. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚ • We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ • We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚ • We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures. • To the extent necessary for PHP to meet its obligations as a secondary carrier under NM regulations, PHP shall make payments for services that are received from non- participating providers, provided outside the service area, or that are not covered under the terms of the contract or evidence of coverage.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚  Employee/Dependent Rule •  The plan, which covers you as an employee, pays first. •  The plan, which covers you as a Dependent, pays second. ⮚  Birthday Rule for Dependent children of parents who are not separated or divorced •  The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. •  If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚  Dependent children of separated or divorced parents •  The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. •  In the absence of a court order: o The plan of the parent with physical custody of the child pays first. o The plan of the Spouse Spouse/Domestic Partner of the parent with physical custody (i.e., the stepparent) pays second. o The plan of the parent not having physical custody of the child pays third. ⮚  Active/Inactive Employee •  The plan, which covers you as an active employee (or Dependent of an active employee), pays first. •  The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚  Longer/Shorter Employment •  In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚  No Coordination Provision •  In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚  If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy.  If you or your Dependents are Covered by COBRA continuation and are also Covered by another group plan, you shall receive our Covered Benefits to the extent that we will be secondary payer of all eligible charges, subject to the terms, conditions, exclusions and limitations of this Agreement. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚  We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚  We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚  We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures.

Coordination of Benefits. If you have medical a participant is covered by another employer’s benefit plan or another group type health benefit plan, there may be some duplication of benefit coverage between this Plan and the other plan. The Plan coordinates benefits with other plans to prevent duplication of payments for the same services. This section describes how Coordination of Benefits (COB) works under any the Plan. To determine how the plans coordinate benefits, one plan is considered “primary” and the other is considered “secondary”. The primary plan pays benefits first, up to that plan’s limits. The secondary plan will not pay benefits until the primary plan pays or denies a claim. In no instance will the primary and secondary plans pay, in total, more than the actual cost of the healthcare services. If the other plan does not include a coordination of benefits or non-duplication provision, that plan will be primary. The following are the provisions for determining which plan will be “primary”: Description Primary Secondary Active Employee Teamsters Local 170 Other Health Benefits Plan, other public or private group programs, or any other health insurance policyPlan Note: If employee is Health and Welfare Fund covered as an “employee” under two plans, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim the employee for the longest period of time is made are considered the primary plan. Dependent spouse with other Other Health Plan Teamsters Local170 coverage as follows“active employee” Health and Welfare Fund Active Employee & Spouse Follow birthday rule* Follow birthday rule* with children: ⮚ both parents’ health plans cover children Active Employee/Dependent Rule • The plan, which covers you as an employeedivorced or Follow court decree Follow court decree separated, pays first. • The planboth parents’ health plans cover children with court order *Under the birthday rule, which covers you as a Dependent, pays second. ⮚ Birthday Rule for Dependent children the plan of parents who are not separated or divorced • The plan, which covers the parent whose birthday falls earlier earliest in the year, pays firstcalendar year is the child’s primary plan. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • If both parents have the same month and day of birthbirthday, the parent who has been covered longer has the primary plan. If the other plan that Covered does not have the parent longerbirthday rule, then the rule in the other plan will pay claims first. The plan determine which covered the parent for a shorter period of time pays second. ⮚ Dependent children of separated or divorced parents • The plan of the parent decreed by a court of law to have responsibility for medical coverage pays firstis primary. • In If parents are divorced or separated and both parents’ plans cover a dependent child, benefits for the absence of a court child are determined in this order: o The • First, the plan of the parent with physical custody of custody; • Then, the child pays first. o The plan of the Spouse stepparent (spouse of the parent with physical custody (i.e.of the child); and • Finally, the stepparent) pays second. o The plan of the parent not having physical custody of the child pays third. ⮚ Active/Inactive Employee • The plan, which covers you as an active employee (or Dependent of an active employee), pays first. • The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚ Longer/Shorter Employment • In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ No Coordination Provision • In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚ We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚ We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedureschild.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. Coordination of Benefits (COB) applies to this Agreement when a Member has medical benefits under more than one plan. The objective of COB is to make sure the combined payments of the plans are no more than your actual medical bills. PHP coordinates benefits according to the “Standard Other Insurance Rule”. Please contact the Presbyterian Customer Service Center for additional information on this rule. Also, each plan determines the maximum allowable payment for a given service and this maximum allowable may vary by plan. For this reason, there is no guarantee that 100 percent (100%) of the charges will be paid even when a Member has more than one medical plan. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚ • Employee/Dependent Rule • o The plan, which covers you as an employee, pays first. • o The plan, which covers you as a Dependent, pays second. ⮚ • Birthday Rule for Dependent children of parents who are not separated or divorced • o The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • o If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚ • Dependent children of separated or divorced parents • o The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • o In the absence of a court order: o ▪ The plan of the parent with physical custody of the child pays first. o ▪ The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o ▪ The plan of the parent not having physical custody of the child pays third. ⮚ • Active/Inactive Employee • o The plan, which covers you as an active employee (or Dependent of an active employee), pays first. • o The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚ • Longer/Shorter Employment • o In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ • No Coordination Provision • o In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ • If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. • If you or your Dependents are Covered by COBRA continuation and are also Covered by another group plan, you shall receive our Covered Benefits to the extent that we will be secondary payer of all eligible charges, subject to the terms, conditions, exclusions and limitations of this Agreement. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚ • We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ • We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚ • We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures. • To the extent necessary for PHP to meet its obligations as a secondary carrier under NM regulations, PHP shall make payments for services that are received from non- participating providers, provided outside the service area, or that are not covered under the terms of the contract or evidence of coverage. Medicare‌‌ If you are enrolled in Medicare, the Covered Benefits provided by this Agreement are not designed to duplicate any benefit to which you are entitled under the Social Security Act. Covered Benefits will be coordinated in compliance with current applicable federal regulations. HSA Note: If you are entitled to and/or enrolled in Medicare, then you may not be eligible to contribute to a Health Savings Account (HSA). Please contact your HSA administrator or financial institution for further information.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. Coordination of Benefits (COB) applies to this Agreement when a Member has medical benefits under more than one plan. The objective of COB is to make sure the combined payments of the plans are no more than your actual medical bills. PIC coordinates benefits according to the “Standard Other Insurance Rule”. Please contact the Presbyterian Customer Service Center for additional information on this rule. Also, each plan determines the maximum allowable payment for a given service and this maximum allowable may vary by plan. For this reason, there is no guarantee that 100 percent of the charges will be paid even when a Member has more than one medical plan. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚ • Employee/Dependent Rule • o The plan, which covers you as an employee, pays first. • o The plan, which covers you as a Dependent, pays second. ⮚ • Birthday Rule for Dependent children of parents who are not separated or divorced • o The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • o If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚ • Dependent children of separated or divorced parents • o The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • o In the absence of a court order: o ▪ The plan of the parent with physical custody of the child pays first. o ▪ The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o ▪ The plan of the parent not having physical custody of the child pays third. ⮚ • Active/Inactive Employee • o The plan, which covers you as an active employee (or Dependent of an active employee), pays first. • o The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚ • Longer/Shorter Employment • o In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ • No Coordination Provision • o In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ • If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. • If you or your Dependents are Covered by COBRA continuation and are also Covered by another group plan, you shall receive our Covered Benefits to the extent that we will be secondary payer of all eligible charges, subject to the terms, conditions, exclusions and limitations of this Agreement. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚ • We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ • We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚ • We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group Most health care programs, including this Hospitalization Program contain a coordination of benefits provision. This provision is used when you, your spouse or any your covered dependents are eligible for payment under more than one health care plan. The object of coordination of benefits is to ensure that your covered expenses will be paid, while preventing duplicate benefit payments. Here is how the coordination of benefits provision works: • When your other health insurance policy, the benefits provided coverage does not mention "coordination of benefits," then that coverage pays first. Benefits paid or payable hereunder shall by the other coverage will be reduced to taken into account in determining if additional benefit payments can be made under your plan. • When the extent that benefits are available to you under such other plan, policy or program. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim person who received care is made are as follows: ⮚ Employee/Dependent Rule • The plan, which covers you covered as an employeeemployee under one contract, and as a dependent under another, then the employee coverage pays first. • The planWhen a dependent child is covered under two health plans, which covers you as a Dependent, pays second. ⮚ Birthday Rule for Dependent children of parents who are not separated or divorced • The plan, which covers the health plan covering the parent whose birthday falls earlier in the year, calendar year pays first. The planBut, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • If if both parents have the same month and day of birthbirthday, the plan that Covered the parent longer, will pay claims first. The health plan which covered the parent for a shorter period of time pays secondlonger will be the primary plan. ⮚ Dependent children of If the dependent child's parents are separated or divorced parents • divorced, the following applies: − The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • In the absence of a court order: o The plan of the parent with physical custody of the child pays first. o − The plan of the Spouse coverage of the parent with physical custody (i.e., pays first but the stepparent) 's coverage pays second. o The plan before the coverage of the parent who does not having physical custody have custody. − Regardless of which parent has custody, whenever a court decree specifies the child pays third. ⮚ Active/Inactive Employee • The planparent who is financially responsible for the child's health care expenses, which covers you as an active employee (or Dependent the coverage of an active employee), that parent pays first. • When none of the above circumstances applies, the coverage you have had for the longest time pays first, provided that: − The plan, which covers you benefits of a health plan covering the person as an employee other than a laid- off or retired employee or as the dependent of such person shall be determined before the benefits of a plan covering the person as a retired or laid-off or retired employee (or Dependent as a dependent of a retired or such person and if − The other health plan does not have this provision regarding laid-off employee)or retired employees, pays second. ⮚ Longer/Shorter Employment • In and, as a result, plans do not agree on the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ No Coordination Provision • In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination order of benefits, ⮚ We then this rule is disregarded. If you receive more than you should have when your benefits are coordinated, you will be expected to repay any overpayment. Subrogation In general, subrogation means that if you incur health care expenses for injuries caused by another person or organization, the person or organization causing the accident may releasebe responsible for paying these expenses. For example, requestif you or one of your dependents receives Hospital Program benefits for injuries caused by another person or organization, the Fund, or obtain claim information Highmark on behalf of the Fund has the right through subrogation, to seek repayment from any individual the other person or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ We have the right, if we make overpayments because of your failure to report other coverage organization or any other reason, to recover such excess payment from any individual to whom, or applicable insurance company for whom, such payments were madebenefits already paid. ⮚ We will not be obligated to pay See Section 14 for non-Covered Services or Covered Benefits not obtained in compliance with our policies and proceduresdetails about subrogation.

Coordination of Benefits. If you have medical coverage under any other Health Benefits Plan, other public or private group programs, or any other health insurance policy, the benefits provided or payable hereunder shall be reduced to the extent that benefits are available to you under such other plan, policy or program. Coordination of Benefits (COB) applies to this Agreement when a Member has medical benefits under more than one plan. The objective of COB is to make sure the combined payments of the plans are no more than your actual medical bills. PHP coordinates benefits according to the “Standard Other Insurance Rule”. Please contact the Presbyterian Customer Service Center for additional information on this rule. Also, each plan determines the maximum allowable payment for a given service and this maximum allowable may vary by plan. For this reason, there is no guarantee that 100% of the charges will be paid even when a Member has more than one medical plan. The rules establishing the order of benefit determination between this Agreement and any other plan covering a Member not on COBRA continuation on whose behalf a claim is made are as follows: ⮚ • Employee/Dependent Rule • o The plan, which covers you as an employee, pays first. • o The plan, which covers you as a Dependent, pays second. ⮚ • Birthday Rule for Dependent children of parents who are not separated or divorced • o The plan, which covers the parent whose birthday falls earlier in the year, pays first. The plan, which covers the parent whose birthday falls later in the year, pays second. The birthday order is determined by the month and the day of birth, not the year of birth. • o If both parents have the same month and day of birth, the plan that Covered the parent longer, will pay claims first. The plan which covered the parent for a shorter period of time pays second. ⮚ • Dependent children of separated or divorced parents • o The plan of the parent decreed by a court of law to have responsibility for medical coverage pays first. • o In the absence of a court order: o ▪ The plan of the parent with physical custody of the child pays first. o ▪ The plan of the Spouse of the parent with physical custody (i.e., the stepparent) pays second. o ▪ The plan of the parent not having physical custody of the child pays third. ⮚ • Active/Inactive Employee • o The plan, which covers you as an active employee (or Dependent of an active employee), pays first. • o The plan, which covers you as a retired or laid-off employee (or Dependent of a retired or laid-off employee), pays second. ⮚ • Longer/Shorter Employment • o In the case where you are the Subscriber under more than one group health insurance policy, then the plan that has Covered you for a longer period of time will pay first. A change of insurance carrier by the group employer does not constitute the start of a new plan. ⮚ • No Coordination Provision • o In spite of the rules listed above, the plan that has no provision regarding coordination of benefits will pay first. ⮚ • If you are covered under a motor vehicle or homeowner’s insurance policy which provides benefits for medical expenses resulting from a motor vehicle accident or accident in your own home, you shall not be entitled to benefits under this Agreement for injuries arising out of such accident to the extent they are covered by the motor vehicle or home owner’s insurance policy. If we have provided such benefits, we shall have the right to recover any benefits we have provided from you or from the motor vehicle or homeowner’s insurance to the extent they are available under the motor vehicle or homeowner’s insurance policy. • If you or your Dependents are Covered by COBRA continuation and are also Covered by another group plan, you shall receive our Covered Benefits to the extent that we will be secondary payer of all eligible charges, subject to the terms, conditions, exclusions and limitations of this Agreement. In no event shall the Covered Benefits received under this Agreement and all other plans combined exceed the total reasonable actual expenses for the services provided under this Agreement. For purposes of coordination of benefits, ⮚ • We may release, request, or obtain claim information from any individual or organization. In addition, any Member claiming benefits from us shall furnish us with any information which we may require. ⮚ • We have the right, if we make overpayments because of your failure to report other coverage or any other reason, to recover such excess payment from any individual to whom, or for whom, such payments were made. ⮚ • We will not be obligated to pay for non-Covered Services or Covered Benefits not obtained in compliance with our policies and procedures.