Illinois Administrative Code
Title 50 - INSURANCE
Part 2009 - COORDINATION OF BENEFITS
Section 2009.60 - Miscellaneous Provisions
Current through Register Vol. 48, No. 12, March 22, 2024
a) Reasonable Cash Values of Services
A secondary plan that provides benefits in the form of services may recover the reasonable cash value of providing the services from the primary plan, to the extent that benefits for the services are covered by the primary plan and have not already been paid or provided by the primary plan. Nothing in this subsection shall be interpreted to require a plan to reimburse a covered person in cash for the value of services provided by a plan that provides benefits in the form of services.
b) Excess and Other Nonconforming Provisions
c) Allowable Expense. Terms such as "usual and customary", "usual and prevailing", "maximum allowable fee", "eligible expense", or "reasonable and customary" may be substituted for the term "necessary, reasonable and customary". Terms such as "medical care" or "dental care" may be substituted for "health care" to describe the coverages to which the COB provisions apply.
d) Subrogation. The COB concept clearly differs from that of traditional subrogation. Provisions for one may be included in health care benefits contracts without compelling the inclusion or exclusion of the other.