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Coordination of Benefits Definitions
Following are definitions of some of the terms used throughout the Coordination of Benefits section.
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Plan — Any of the following that provide benefits or services for, or because of, medical, dental, vision or prescription drug care:
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Group, blanket or franchise health insurance policies issued by insurers including health care service contractors
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Group prepaid coverage under service plan contracts or under group or individual practice plans
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Labor management trusteed plans, labor organization plans, employer organization plans or employee benefit organization plans
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Medical coverage in government programs
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Other group-type coverage that is not available to the general public and can be obtained and maintained only through membership in, or connection with, a particular organization or group.
Each contract or other arrangement for coverage described above is a separate plan. If an arrangement has two or more parts and coordination of benefits applies only to one part, each part is considered a separate plan.
The term "plan" does not include the following:
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Individual or family benefits provided through insurance contracts, subscriber contracts, coverage through health maintenance organizations or other prepayment, service, group practice or individual practice plans
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Group or group-type hospital indemnity benefits of $100 per day or less paid on other than an expense-incurred basis and reimbursement-type benefits where the insured has the right to elect indemnity-type benefits in lieu of reimbursement benefits at the time of the claim. However, the term "plan" does include the amount of benefits exceeding $100 per day
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School accident-type coverage for elementary school, high school or college students for accidents only, including athletic injuries, either on a 24-hour basis or on a to-and-from-school basis.
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This plan
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The Full-Time/Part-Time Option 1 Trust Vision Plan
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The Full-Time/Part-Time Option 1 Dental Plan
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The Full-Time/Part-Time Option 1, Part-Time Option 2 Trust Prescription Drug Plan.
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