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Agenda - 06-28-1989
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Agenda - 06-28-1989
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3/10/2017 4:29:57 PM
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BOCC
Date
6/28/1989
Meeting Type
Regular Meeting
Document Type
Agenda
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48 <br /> that person as that employee's dependent. If the other plan <br /> is not subject to this rule, and if, as a result, the plans <br /> do not agree on the order of benefits, this paragraph shall <br /> not apply. <br /> 10. If none of the rules in this section determine the order of <br /> benefits, the benefits of the plan which covered an employee, <br /> member, or subscriber for a longer period of time are <br /> determined before those of the plan which covered that person <br /> . for the shorter period of time. <br /> If the Group Benefit Plan happens to be another HMO, the above rules <br /> should be followed in determining which plan a member should receive <br /> services from. <br /> The Plan shall be entitled to: <br /> (1) determine whether and to what extent a Member has indemnity <br /> or other coverage for the Health Services provide under this <br /> • Contract; <br /> (2) establish priorities in accordance with paragraphs 1 through <br /> 10 above, for primary responsibility among the plans obliged <br /> to provide Health Services or indemnity benefits; <br /> (3) release to or obtain from any other plan any information <br /> needed to implement this provision; and <br /> (4) recover the value of Health Services rendered to the Member <br /> under this Contract to the extent that such Health Services <br /> are actually provided and/or indemnified by any other plan. <br /> 43 <br />
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