28 Tex. Admin. Code § 3.3506 - Use of the Term "Plan" in Contracts
(a)
Separate parts of a plan for members of a group that are provided through
alternative contracts that are intended to be part of a coordinated package of
benefits are considered one plan, and there is no COB among the separate parts
of the plan.
(b) If a plan
coordinates benefits, its contract must state the types of coverage that will
be considered in applying the COB provision of that contract. Whether the
contract uses the term "plan" or some other term such as "program," the
contractual definition may be no broader than the definition of "plan" in this
subchapter. The model COB contract provisions provide an example of how to
define "plan" in §
3.3510(d) of
this title (relating to Model COB Contract Provisions).
(c) A contract may apply one COB provision to
certain benefits, such as dental benefits, coordinating only with like
benefits, and may apply other separate COB provisions to coordinate other
benefits.
Notes
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