Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 38.00 - Coordination of Benefits (COB)
Section 38.08 - Miscellaneous Provisions
Current through Register 1531, September 27, 2024
(1) A Secondary Plan that provides benefits in the form of services may recover the reasonable value of 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 211 CMR 38.08 shall be interpreted to require a Plan to reimburse a covered person in cash for the value of services provided by a Plan which provides benefits in the form of services.
(2)
(3) COB Differs from Subrogation. Provisions for one may be included in health care benefits contracts without compelling the inclusion or exclusion of the other.
(4) If the Plans cannot agree on the order of benefits within 30 calendar days after the Plans have received all of the information needed to pay the Claim, the Plans shall immediately pay the Claim in equal shares and determine their relative liabilities following payment, except that no Plan shall be required to pay more than it would have paid had it been the Primary Plan.