Primary Payer Sample Clauses
Primary Payer. The amount of our payment, if any, when we coordinate benefits under this Part, is based on whether or not AvMed is the primary payer. When we are primary, we will pay for Covered Services without regard to coverage under other plans. When AvMed is not primary, our payment for Covered Services may be reduced so that total benefits under all your plans will not exceed 100% of the total reasonable expenses actually incurred for Covered Services. For purposes of this Part, in the event you receive Covered Services from a Participating Provider, ‘total reasonable expenses’ shall mean the amount we are obligated to pay to the provider pursuant to the applicable provider agreement we have with such provider; or if there is no such provider agreement, the amount we are obligated to pay the provider pursuant to state or federal law.
Primary Payer. An insurance policy, plan, or program that pays first on a claim for medical care. This could be Medicare or other health insurance. Medicare is primary payer in the following situations:
a. Individual has ESRD, is covered by COBRA and is after the first 30 months of eligibility or entitlement to Medicare
b. Individual is disabled and covered by Medicare & COBRA