Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 38.00 - Coordination of Benefits (COB)
Section 38.03 - COB Contract Provisions
Universal Citation: 211 MA Code of Regs 211.38
Current through Register 1531, September 27, 2024
(1) Any Plan which contains a COB provision must provide information to persons covered under the Plan about its COB provision and the rules used to determine whether it is a Primary Plan or Secondary Plan and to determine and calculate Allowable Expense.
(2) A COB provision may not be used that permits a Plan to reduce its benefits on the basis that:
(a) Another Plan exists and the covered
person did not enroll in that Plan;
(b) A person is or could have been covered
under another Plan, except with respect to Part B of Medicare; or
(c) A person has elected an option under
another Plan providing a lower level of benefits than another option that could
have been elected.
(d) No Plan may
contain a COB provision that its benefits are "always excess" or "always
secondary" except in accordance with the rules permitted by
211 CMR 38.00.
(e) No Plan may use a COB provision, or any
other provision that allows it to reduce its benefits with respect to any other
coverage its insured may have, that does not meet the definition of
211 CMR 38.02:
Plan.
Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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