Common use of Longer or Shorter Length of Coverage Clause in Contracts

Longer or Shorter Length of Coverage. The plan that covered the member as an employee, subscriber or retiree longer is the Primary plan and the plan that covered the member the shorter period of time is the Secondary plan. If the preceding rules do not determine the order of benefits, the allowable expenses shall be shared equally between the plans meeting the definition of Plan. In addition, this Plan will not pay more than we would have paid had we been the primary plan. Effect on the Benefits of this Plan When this plan is Secondary, we can reduce our benefits so that the total benefits paid or provided by all plans during a plan year are not more than the total allowable expenses. In determining the amount to be paid for any claim, the Secondary plan will calculate the benefits it would have paid in the absence of other health care coverage and apply that calculated amount to any allowable expenses under its plan that is unpaid by the Primary plan. The Secondary plan can then reduce its payment by the amount so that, when combined with the amount paid by the Primary plan, the total benefits paid or provided by all plans for the claim do not exceed the total allowable charges for that claim. In addition, the Secondary plan shall credit to its plan deductible any amounts it would have credited to its deductible in the absence of other health care coverage. If a member is enrolled in two or more closed panel plans and if, for any reason, including the provision of services by a non-panel provider, benefits are not payable by one closed panel plan; COB shall not apply between that plan and other closed panel plans. Right to Receive and Release Needed Information Certain facts about health care coverage and services are needed to apply this COB section and to determine benefits payable under this Plan and other plans. We can get the facts we need from, or give them to, other organizations or persons for the purpose of applying this section and determining benefits payable under this Plan and other plans covering a member claiming benefits. We need not tell, or get the consent of, any person to do this. Each member claiming benefits under this Plan must give us any facts we need to apply this section and determine benefits payable. Facility of Payment A payment made under another plan can include an amount that should have been paid under this plan. If it does, we can pay that amount to the organization that made that payment. That amount will then be treated as though it were a benefit paid under this plan. We will not have to pay that amount again. The term “payment made” includes providing benefits in the form of services, in which case “payment made” means the reasonable cash value of the benefits provided in the form of services.

Longer or Shorter Length of Coverage. The plan that covered the member Member as an employee, subscriber or retiree longer is the Primary primary plan and the plan that covered the member Member the shorter period of time is the Secondary secondary plan. If the preceding rules do not determine the order of benefits, the allowable expenses Allowable Charge shall be shared equally between the plans meeting the definition of Planplan. In addition, this Plan will not pay more than we would have paid had we been the primary plan. Effect on the Benefits of this Plan When this plan Plan is Secondarysecondary, we can reduce our benefits so that the total benefits paid or provided by all plans during a plan year are not more than the total allowable expensesexpense. In determining the amount to be paid for any claimClaim, the Secondary secondary plan will calculate the benefits it would have paid in the absence of other health care coverage and apply that calculated amount to any allowable expenses expense under its plan that is unpaid by the Primary primary plan. The Secondary secondary plan can then reduce its payment by the amount so that, when combined with the amount paid by the Primary primary plan, the total benefits paid or provided by all plans for the claim Claim do not exceed the total allowable charges Allowable Charge for that claimClaim. In addition, the Secondary secondary plan shall credit to its plan deductible Deductible any amounts it would have credited to its deductible Deductible in the absence of other health care coverage. If a member Member is enrolled in two or more closed panel plans and if, for any reason, including the provision of services Services by a non-panel provider, benefits are not payable by one closed panel plan; COB shall not apply between that plan and other closed panel plans. Right to Receive and Release Needed Information Certain facts about health care coverage and services Services are needed to apply this COB section and to determine benefits payable under this Plan and other plans. We can get the facts we need from, or give them to, other organizations or persons for the purpose of applying this section and determining benefits payable under this Plan and other plans covering a member Member claiming benefits. We need not tell, or get the consent of, any person to do this. Each member Member claiming benefits under this Plan must give us any facts we need to apply this section and determine benefits payable. Facility of Payment A payment made under another plan can include an amount that should have been paid under this planPlan. If it does, we can pay that amount to the organization that made that payment. That amount will then be treated as though it were a benefit paid under this planPlan. We will not have to pay that amount again. The term “payment made” includes providing benefits in the form of servicesServices, in which case “payment made” means the reasonable cash value of the benefits provided in the form of servicesServices.

Longer or Shorter Length of Coverage. The plan that covered the member as an employee, subscriber or retiree longer is the Primary plan and the plan that covered the member the shorter period of time is the Secondary plan. If the preceding rules do not determine the order of benefits, the allowable Allowable expenses shall be shared equally between the plans meeting the definition of Plan. In addition, this Plan will not pay more than we would have paid had we been the primary plan. Effect on the Benefits of this Plan When this plan Plan is Secondary, we can reduce our benefits so that the total benefits paid or provided by all plans during a plan year are not more than the total allowable Allowable expenses. In determining the amount to be paid for any claim, the Secondary plan will calculate the benefits it would have paid in the absence of other health care coverage and apply that calculated amount to any allowable expenses Allowable charges under its plan that is unpaid by the Primary plan. The Secondary plan can then reduce its payment by the amount so that, when combined with the amount paid by the Primary plan, the total benefits paid or provided by all plans for the claim do not exceed the total allowable Allowable charges for that claim. In addition, the Secondary plan shall credit to its plan deductible any amounts it would have credited to its deductible in the absence of other health care coverage. If a member is enrolled in two or more closed panel plans and if, for any reason, including the provision of services by a non-panel provider, benefits are not payable by one closed panel plan; COB shall not apply between that plan and other closed panel plans. Right to Receive and Release Needed Information Certain facts about health care coverage and services are needed to apply this COB section and to determine benefits payable under this Plan and other plans. We can get the facts we need from, or give them to, other organizations or persons for the purpose of applying this section and determining benefits payable under this Plan and other plans covering a member claiming benefits. We need not tell, or get the consent of, any person to do this. Each member claiming benefits under this Plan must give us any facts we need to apply this section and determine benefits payable. Facility of Payment A payment made under another plan can include an amount that should have been paid under this planPlan. If it does, we can pay that amount to the organization that made that payment. That amount will then be treated as though it were a benefit paid under this planPlan. We will not have to pay that amount again. The term “payment made” includes providing benefits in the form of services, in which case “payment made” means the reasonable cash value of the benefits provided in the form of services.

Longer or Shorter Length of Coverage. The plan that covered the member person as an employee, subscriber employee or retiree longer is the Primary primary plan and the plan that covered the member person the shorter period of time is the Secondary secondary plan. If the preceding rules do not determine the order of benefits, the allowable expenses shall be shared equally between the plans meeting the definition of Planplan. In addition, this Plan plan will not pay more than we it would have paid had we it been the primary plan. Effect on the Benefits of this This Plan When this plan is Secondarysecondary, we can it may reduce our its benefits so that the total benefits paid or provided by all plans during a plan year are not more than the total allowable expenses. In determining the amount to be paid for any claim, the Secondary secondary plan will calculate the benefits it would have paid in the absence of other health care coverage and apply that calculated amount to any allowable expenses expense under its plan that is unpaid by the Primary primary plan. The Secondary secondary plan can may then reduce its payment by the amount so that, when combined with the amount paid by the Primary primary plan, the total benefits paid or 61 provided by all plans for the claim do not exceed the total allowable charges expense for that claim. In addition, the Secondary secondary plan shall credit to its plan deductible any amounts it would have credited to its deductible in the absence of other health care coverage. If a member covered person is enrolled in two or more closed panel plans and if, for any reason, including the provision of services service by a non-panel provider, benefits are not payable by one closed panel plan; , COB shall not apply between that plan and other closed panel plans. Right to Receive and Release Needed Information Certain facts about health care coverage and services are needed to apply this these COB section rules and to determine benefits Benefits payable under this Plan plan and other plans. We can get Blue Cross and Blue Shield of Montana may obtain the facts we need from, and information it needs from or give them to, provide such facts and information to other organizations or persons for the purpose of applying this section these COB rules and determining benefits Benefits payable under this Plan and other plans covering a member the Member claiming benefitsBenefits. We Blue Cross and Blue Shield of Montana need not tellinform, or get the consent of, any person to do thisobtain such information. Each member Member claiming benefits Benefits under this Plan must give us provide Blue Cross and Blue Shield of Montana any facts we need it needs to apply this section those rules and determine benefits Benefits payable. Facility of Payment A payment made under another plan can may include an amount that should have been paid under this plan. If it does, we can Blue Cross and Blue Shield of Montana may pay that amount to the organization that made that payment. That amount will then be treated as though it were a benefit Benefit paid under this plan. We Blue Cross and Blue Shield of Montana will not have to pay that amount again. The term “"payment made” " includes providing benefits Benefits in the form of services, in which case “"payment made” " means the reasonable cash value of the Benefits provided in the form of services. Right of Recovery If the amount of the payments made by Blue Cross and Blue Shield of Montana is more than it should have paid under this COB provision, it may recover the excess from one or more of the Members it has paid or for whom it has paid; or any other person or organization that may be responsible for the benefits or services provided for the Member. The "amount of the payments made" includes the reasonable cash value of any benefits provided in the form of services.