Order of Benefit Determination definition

Order of Benefit Determination means the procedure used to decide which plan will determine its benefits before any other plan.
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Order of Benefit Determination means the procedure used to decide which plan will determine its benefits before any other plan. Each policy, contract or other arrangement for benefits or services will be treated as a separate plan. Each part of The Empire Plan that reserves the right to take the benefits or services of other plans into account to determine its benefits will be treated separately from those parts that do not.
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Order of Benefit Determination means the procedure used to decide which plan will determine its benefits before any other plan. Each policy, contract or other arrangement for benefits or services will be treated as a separate plan. Each part of The Empire Plan that reserves the right to take the benefits or services of other plans into account to determine its benefits will be treated separately from those parts that do not.C. When coordination of benefits applies and The Empire Plan is secondary, payment under The Empire Plan will be reduced so that the total of all payments or benefits payable under The Empire Plan and under another plan is not more than the total allowable charge for the service you receive.D. Payments under The Empire Plan will not be reduced on account of benefits payable under another plan if the other plan has a Coordination of Benefits or similar provision with the same order of benefit determination as stated in Item E. and under that order of benefit determination, the benefits under The Empire Plan are to be determined before the benefits under the other plan.E. When more than one plan covers the person making the claim, the order of benefit payment is determined using the first of the following rules that applies:1. The benefits of the plan that covers the person as an enrollee are determined before those of other plans that cover that person as a dependent;2. When this Plan and another plan cover the same child as a dependent of different persons called “parents” and the parents are not divorced or separated (For coverage of a dependent of parents who are divorced or separated, see paragraph 3. below)
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Examples of Order of Benefit Determination in a sentence

  • Order of Benefit Determination Rules.When a Member is covered by two or more plans, the rules for determining the order of benefit payments are as follows: A.

  • You will find the rules under Order of Benefit Determination Rules in this section.The Order of Benefit Determination Rules will be used to determine which plan is the primary plan.

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

  • If an Insured is covered by more than one Secondary Plan, the Order of Benefit Determination rules in this provision shall decide the order in which the Secondary Plan’s benefits are determined in relation to each other.

  • Order of Benefit Determination - Each Plan determines its order of benefits using the first of the following rules that apply: 1.

  • If the order of benefit determination provisions of the Other Plan do not agree under these circumstances with the Order of Benefit Determination provisions of This Plan, this rule will not apply.6. When the above rules do not establish the order of payment, the plan on which you have been enrolled the longest pays first unless two of the plans have the same effective date.

  • Order of Benefit Determination Rules.When an Enrollee is covered by two or more plans, the rules for determining the order of benefit payments are as follows: A.

  • Order of Benefit Determination RulesWhen a Member is covered by two or more plans, the rules for determining the order of benefit payments are as follows:1.

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

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


More Definitions of Order of Benefit Determination

Order of Benefit Determination means the order in which each Group Plan pays benefits, i.e. which plan pays first (primary); which plan pays second (secondary).
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Related to Order of Benefit Determination

  • Adverse Benefit Determination means any of the following:

  • Reset Determination Date means, in respect of the First Reset Period, the second Business Day prior to the First Reset Date and, in respect of each Subsequent Reset Period thereafter, the second Business Day prior to the first day of each such Subsequent Reset Period;

  • SOFR Determination Date has the meaning specified in the definition of “Daily Simple SOFR”.

  • Disability benefits means any cash payments which are payable to a covered individual for all or part of a period of disability pursuant to P.L.1948, c.110 (C.43:21-25 et al.).