Welfare Summary Plan Description

15.6 ADMINISTRATION OF COB

To administer COB, the Plan reserves the right to:

  • exchange information with other plans involved in paying claims;
  • require that you, your physician, or your Health Care Provider furnish any necessary information;
  • reimburse any plan that made payments this Plan should have made; or
  • recover any overpayment.

If this Plan should have paid benefits that were paid by any other plan, this Plan may pay the party that made the other payments in the amount this Plan determines to be proper under this provision. Any amounts so paid will be considered to be benefits under this Plan, and this Plan will be fully discharged from any liability it may have to the extent of such payment.

To obtain all the benefits available to you, you should file a claim under each plan that covers the person for the expenses that were incurred. However, any person who claims benefits under this Plan must provide all the information the Plan needs to apply COB.

If this Plan is secondary, and if the coordinating primary plan provides benefits in the form of services, this Plan will consider the reasonable cash value of each service to be both the Allowable Expense and the benefits paid by the primary plan.

If this Plan is secondary, and if the coordinating primary plan does not cover health care services because they were obtained "out-of-network," benefits for services covered by this Plan will be payable by this Plan only to the extent they would have been payable if this Plan were the primary plan.

If this Plan determines that it is the secondary payor, and if the coordinating plan determines that it is also secondary because:

  • it provides by its terms that it is always secondary or excess to any other coverage; or
  • it does not use the same order of benefit determination rules as this Plan;

and if this Plan advances an amount equal to the benefits it would have paid had it been the primary plan, this Plan will be subrogated to all rights the Participant may have against the other plan, and the Participant shall execute any documents required or requested by this Plan to pursue any claims against the other plan for reimbursement of the amount advanced by this Plan.