211 CMR 38.03 - COB Contract Provisions

Current through Register 1466, April 1, 2022

(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.

Notes

211 CMR 38.03

Amended by Mass Register Issue 1323, eff. 10/7/2016. Amended by Mass Register Issue 1325, eff. 10/7/2016.