760 Ind. Admin. Code 1-38.1-17

Current through October 9, 2024

Section 760 IAC 1-38.1-17 - Secondary plan procedures; total allowable expenses

Authority: IC 27-1-3-7

Affected: IC 27-8-5-19

Sec. 17.

In determining the amount to be paid by the secondary plan on a claim, should the plan wish to coordinate benefits, the secondary plan shall calculate the benefits it would have paid on the claim in the absence of other health coverage and apply that calculated amount to any allowable expense under its plan that is unpaid by the primary plan. The secondary plan:

(1) may reduce its payment by the amount so that, when combined with the amount paid by the primary plan, the total benefits paid or provided by all plans for the claim do not exceed one hundred percent (100%) of the total allowable expense for that claim; and

(2) shall credit to its plan deductible any amounts it would have credited to its deductible in the absence of other health care coverage.

760 IAC 1-38.1-17

Department of Insurance; 760 IAC 1-38.1-17; filed Feb 14, 1990, 3:30 p.m.: 13 IR 1173; readopted filed Sep 14, 2001, 12:22 p.m.: 25 IR 531; filed Sep 15, 2006, 2:02 p.m.: 20061011-IR-760050265FRA; readopted filed Nov 21, 2012, 4:15 p.m.: 20121219-IR-760120454RFA

Readopted filed Nov 13, 2018, 10:02 a.m.: 20181212-IR-760180372RFA