This Plan definition

This Plan means, in a COB provision, the part of the contract providing the health care benefits to which the COB provision applies and which may be reduced because of the benefits of other plans. Any other part of the contract providing health care benefits is separate from this plan. A contract may apply one COB provision to certain benefits, such as dental benefits, coordinating only with similar benefits, and may apply another COB provision to coordinate other benefits.
This Plan means, in a COB provision, the part of the contract providing the dental benefits to which the COB provision applies and which may be reduced because of the benefits of other Plans. Any other part of the contract providing dental benefits is separate from This Plan. A contract may apply one COB provision to certain benefits, such as dental benefits, coordinating only with similar benefits, and may apply another COB provision to coordinate other benefits.The order of benefit determination rules determine whether This Plan is a Primary Plan or Secondary Plan when you have dental coverage under more than one Plan.When This Plan is primary, it determines payment for its benefits first before those of any other Plan without considering any other Plan’s benefits. When This Plan is secondary, it determines its benefits after those of another Plan and must make payment in an 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 are coordinated up to 100 percent of the total Allowable Expense for that claim. This means that when This Plan is secondary, it must pay the amount which, when combined with what the Primary Plan paid, does not exceed 100 percent of the Allowable Expense. In addition, if This Plan is secondary, it must calculate its savings (its amount paid subtracted from the amount it would have paid had it been the Primary Plan) and record these savings as a benefit reserve for you. This reserve must be used to pay any expenses during that calendar year, whether or not they are an Allowable Expense under This Plan. If This Plan is secondary, it will not be required to pay an amount in excess of its maximum benefit plus any accrued savings.
This Plan means this Policy.

Examples of This Plan in a sentence

  • Eligibility for This Plan Eligibility of a MemberMembers may be accepted for enrollment and continuing coverage hereunder only upon meeting all of the applicable requirements below.1. Your Group's eligibility requirements that we have approved (your Group is required to inform Subscribers of the Group's eligibility requirements) and meet the Subscriber or Dependent eligibility requirements below.2. You must work or reside inside our Service Area to be eligible for this Plan.

  • That amount will then be treated as though it were a benefit paid under This Plan.

  • Those rules determine whether the benefits of This Plan are determined before or after those of another Plan.

  • First, the plan expressly places the burden on the claimant—Plaintiff—to prove disability:In order to receive benefits under This Plan, you must provide to us at your expense, and subject to our satisfaction .

  • When there are more than two Plans covering the person, This Plan may be a Primary Plan as to one or more other Plans, and may be a Secondary Plan as to a different Plan or Plans.


More Definitions of This Plan

This Plan means the part of this Benefit Plan and any amendments/endorsements thereto that provides Benefits for healthcare expenses.
This Plan means the part of the Plan that provides health care benefits.
This Plan means the part of the Group’s Benefit Plan and any amendments/endorsements thereto that provides Benefits for health care expenses.
This Plan means this Certificate.
This Plan as used in this provision means that portion of the contract by name referred to in this document which provides the benefits that are subject to this provision.
This Plan means the dental coverage provided for you and your Eligible Dependents pursuant to this Certificate.
This Plan means, in a COB provision, the part of the contract providing the health care benefits to which the COB provision applies and which may be reduced because of the benefits of other plans. Any other part of the contract providing health care benefits is separate from this plan. A contract may apply one COB provision to certain benefits, such as dental benefits, coordinating only with like benefits, and may apply other separate COB provisions to coordinate other benefits.The order of benefit determination rules determine whether this plan is a primary plan or secondary plan when the person has health care coverage under more than one plan. When this plan is primary, it determines payment for its benefits first before those of any other plan without considering any other plan’s benefits. When this plan is secondary, it determines its benefits after those of another plan and may reduce the benefits it pays so that all plan benefits equal 100 percent of the total allowable expense