OAR 836-020-0791
Procedure to be Followed by Secondary Plan to Calculate Benefits and Pay a Claim

(1)

In determining the amount to be paid by the secondary plan on a claim, should the plan wish to coordinate benefits, the secondary plan shall calculate the benefits it would have paid on the claim in the absence of other health care coverage and apply that calculated amount to any allowable expense under its plan that is unpaid by the primary plan.

(2)

The secondary plan may reduce its payment by the amount so that, when combined with the amount paid by the primary plan, the total benefits paid or provided by all plans for the claim do not exceed 100 percent of the total allowable expense for that claim.

(3)

In addition, the secondary plan shall credit to its plan deductible any amounts it would have credited to its deductible in the absence of other health care coverage.

Source: Rule 836-020-0791 — Procedure to be Followed by Secondary Plan to Calculate Benefits and Pay a Claim, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-020-0791.

836‑020‑0200
Purpose and Authority 836‑020‑0205
Applicability 836‑020‑0210
Definitions 836‑020‑0215
Method of Disclosure of Required Information 836‑020‑0220
Form and Content of Advertisements 836‑020‑0225
Advertisements of Benefits Payable, Losses Covered, or Premiums Payable 836‑020‑0230
Necessity for Disclosing Policy Provisions Relating to Renewal, Cancellation, and Termination 836‑020‑0235
Testimonials or Endorsements by Third Parties 836‑020‑0240
Use of Statistics 836‑020‑0245
Identification of Plan or Number of Policies 836‑020‑0250
Disparaging Comparisons and Statements 836‑020‑0255
Licensed Jurisdictions and Status of Insurer 836‑020‑0260
Identity of Insurer and Policy 836‑020‑0265
Group or Quasi-Group Implication 836‑020‑0270
Introductory, Initial, or Special Offers 836‑020‑0275
Statements About an Insurer 836‑020‑0280
Enforcement Procedures 836‑020‑0285
Prior Approval 836‑020‑0290
Severability 836‑020‑0295
Effective Date 836‑020‑0300
Statutory Authority 836‑020‑0305
Disclosure 836‑020‑0770
Authority, Purpose and Effective Date of OAR 836-020-0770
to 836-020-0806 836‑020‑0775
Definitions 836‑020‑0780
Use of Model COB Contract Provision 836‑020‑0785
Rules for Coordination of Benefits 836‑020‑0791
Procedure to be Followed by Secondary Plan to Calculate Benefits and Pay a Claim 836‑020‑0796
Notice to Covered Persons 836‑020‑0801
Miscellaneous Provisions 836‑020‑0806
Effective Date for Existing Contracts
Last Updated

Jun. 8, 2021

Rule 836-020-0791’s source at or​.us