28 Tex. Admin. Code § 3.3510 - Model COB Contract Provisions
(a)
Subsection (d) of this section contains an optional model COB provision form
for use in contracts. The use of this model form is subject to the provisions
of §
3.3509 of this title (relating to
Miscellaneous Provisions) and the provisions of §
3.3507 of this title (relating to
Rules for COB and Order of Benefits).
(b) Subsection (e) of this section contains
an optional model plain language description of the COB process that explains
to the covered person how health plans will implement COB. It is not intended
to replace or change the provisions that are set forth in the contract. Its
purpose is to explain the process by which two or more plans will pay for or
provide benefits.
(c) A COB
provision or a plain language description does not have to use the words and
format shown in the model forms. Changes may be made to fit the language and
style of the rest of the contract or to reflect the difference among plans that
provide services, pay benefits for expenses incurred, and indemnify. No
substantive changes are allowed.
(d) The model COB contract provisions are as
follows:
(e) The model COB notice
publication is as follows:
Notes
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