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Agenda - 06-28-1989
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Agenda - 06-28-1989
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BOCC
Date
6/28/1989
Meeting Type
Regular Meeting
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Agenda
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49 <br /> The order of primary responsibility stated above shall not apply <br /> when the Member is entitled to receive Health Services or indemnity <br /> benefits: (a) under Worker's Compensation or similar law; or (b) in a <br /> hospital or facility owned or operated by any governmental agency. In <br /> such cases, the primary responsibility shall rest with those persons or <br /> agencies having the obligation to provide the Health Services or <br /> indemnity benefits under (a) or (b) above. In no case shall the Plan be <br /> required by a hospital or facility owned or operated by any governmental <br /> agency to provide more than the individual would have been required to <br /> pay in the absence of third party coverage. <br /> • <br /> When the Plan Coverage is the primary Coverage, it will provide <br /> all necessary Health Services in accordance with this Contract. The <br /> secondary health plan may be obligated to pay any coinsurance, <br /> Copayment, or other charges not Covered by the Plan if the Member files <br /> a claims with that group health plan. When the Plan's Coverage is <br /> secondary, it reserves the right to request that the Member submit a <br /> claim to the other group health plan, recover any claim payment that the <br /> Member receives from that group health plan to the extent such payment <br /> is for services actually received from or paid for by <br /> the Plan, or to bill that group health plan for Health Services provided <br /> or paid for by the Plan. <br /> 44 <br />
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