02-031 C.M.R. ch. 790, § 2 - Definitions

The following terms, when used in this Rule, shall have the following meanings unless the context clearly indicates otherwise:

A. "Coordination of benefits provision" or "COB provision" means a contractual provision that establishes an order in which plans intend to pay their claims, and describes how benefits provided by the plan will be calculated when the plan is secondary to avoid duplication of payment.

B. "Carrier" means an insurer, a health maintenance organization, a preferred provider arrangement administrator, a fraternal benefit society, a nonprofit hospital or medical service organization or health plan, a multiple-employer welfare arrangement, or a self-insured employer subject to state regulation as described in 24-A M.R.S.A, §2848-A.

C. "Plan" means a health benefit plan issued or administered by a carrier.

D. "Primary plan" means a plan whose benefits for a person's health care coverage must be determined before taking the existence of any other plan into consideration.

E. "Secondary plan" means a plan which is not a Primary Plan.

Notes

02-031 C.M.R. ch. 790, § 2