1.Authorization.
There may be a provision for coordination of benefits payable under the policy and under other plans of insurance or health
care coverage, in conformance with rules adopted by the superintendent to establish uniformity in the permissive use of coordination
of benefits provisions in order to avoid claim delays and misunderstandings that otherwise result from the use of inconsistent
or incompatible provisions among the several insurers and nonprofit hospital or medical service organization plans and nonprofit
health care organization plans. Rules adopted pursuant to this subsection are routine technical rules as defined in Title
5, chapter 375, subchapter II-A.
[
1999, c. 256, Pt. N, §1 (NEW)
.]
2.Coordination with Medicare.
Coordination of benefits with Medicare is governed by the following provisions.
A. The policy may not coordinate benefits with Medicare Part A unless:
(1) The insured is enrolled in Medicare Part A;
(2) The insured was previously enrolled in Medicare Part A and voluntarily disenrolled;
(3) The insured stated on an application or other document that the insured was enrolled in Medicare Part A; or
(4) The insured is eligible for Medicare Part A without paying a premium and the policy states that it will not pay benefits
that would be payable under Medicare even if the insured fails to exercise the insured's right to premium-free Medicare Part
A coverage. [1999, c. 256, Pt. N, §1 (NEW).]
B. The policy may not coordinate benefits with Medicare Part B unless:
(1) The insured is enrolled in Medicare Part B;
(2) The insured was previously enrolled in Medicare Part B and voluntarily disenrolled;
(3) The insured stated on an application or other document that the insured was enrolled in Medicare Part B; or
(4) The insured is eligible for Medicare Part A without paying a premium and the insurer provided prominent notification
to the insured both when the policy was issued and, if applicable, when the insured becomes eligible for Medicare due to age.
The notification must state that the policy will not pay benefits that would be payable under Medicare even if the insured
fails to enroll in Medicare Part B. [1999, c. 790, Pt. D, §7 (AMD).]
C. Coordination is not permitted with Medicare coverage for which the insured is eligible but not enrolled except as provided
in paragraphs A and B. [1999, c. 256, Pt. N, §1 (NEW).]
[
1999, c. 790, Pt. D, §7 (AMD)
.]
3.Credit toward deductible.
When an insured is covered under more than one expense-incurred health plan, payments made by the primary plan, payments
made by the insured and payments made from a health savings account or similar fund for benefits covered under the secondary
plan must be credited toward the deductible of the secondary plan. This subsection does not apply if the secondary plan is
designed to supplement the primary plan.
[
2005, c. 121, Pt. D, §2 (NEW)
.]
SECTION HISTORY
1999, c. 256, §N1 (NEW).
1999, c. 790, §D7 (AMD).
2005, c. 121, §D2 (AMD).
Data for this page extracted on 10/16/2012 08:29:52.