Noblesville Schools Medical Plan 84 Section 7: Coordination of Benefits Section 7: Coordination of Benefits Benefits When You Have Coverage under More than One Plan This section describes how Benefits under the Plan will be coordinated with those of any other plan that provides benefits to you. When Does Coordination of Benefits Apply? This Coordination of Benefits (COB) provision applies to you if you are covered by more than one health benefits plan, including any one of the following: • Another employer sponsored health benefits plan. • A medical component of a group long-term care plan, such as skilled nursing care. • No-fault or traditional "fault" type medical payment benefits or personal injury protection benefits under an auto insurance policy. • Medical payment benefits under any premises liability or other types of liability coverage. • Medicare or other governmental health benefit. If coverage is provided under two or more plans, COB determines which plan is primary and which plan is secondary. The plan considered primary pays its benefits first, without regard to the possibility that another plan may cover some expenses. Any remaining expenses may be paid under the other plan, which is considered secondary. The secondary plan may determine its benefits based on the benefits paid by the Primary Plan. How much this Plan will reimburse you, if anything, will also depend in part on the Allowable Expense. The term, “Allowable Expense,” is further explained below. What Are the Rules for Determining the Order of Benefit Payments? Order of Benefit Determination Rules 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 do not exceed 100% of the total Allowable Expense. The order of benefit determination rules below govern the order in which each Plan will pay a claim for benefits. • Primary Plan. The Plan that pays first is called the Primary Plan. The Primary Plan must pay benefits in accordance with its policy terms without regard to the possibility that another Plan may cover some expenses. • Secondary Plan. The Plan that pays after the Primary Plan is the Secondary Plan. The Secondary Plan may reduce the benefits it pays so that payments from all Plans do not exceed 100% of the total Allowable Expense. Allowable Expense is defined below. When a person is covered by two or more Plans, the rules for determining the order of benefit payments are as follows: A. This Plan will always be secondary to medical payment coverage or personal injury protection coverage under any auto liability or no-fault insurance policy. B. When you have coverage under two or more medical plans and only one has COB provisions, the plan without COB provisions will pay benefits first.