Minnesota Administrative Rules

4685.0940 MODEL COORDINATION OF BENEFITS CONTRACT PROVISION.

Subpart 1.

General.

Use of the model coordination of benefits provision for group contracts in part 4685.0950 is subject to subparts 2 and 3 and part 4685.0915.

Subp. 2.

Flexibility.

A group contract's coordination provision does not have to use the words and format shown in part 4685.0950. Changes may be made to fit the language and style of the rest of the group contract or to reflect the difference among plans that provide services, that pay benefits for expenses incurred, and that indemnify. No other substantive changes are allowed.

Subp. 3.

Prohibited coordination and benefit design.

A.

A group contract may not reduce benefits on the basis that:

(1)

another plan exists;

(2)

a person is or could have been covered under another plan, except with respect to Part B of Medicare; or

(3)

a person has elected an option under another plan providing a lower level of benefits than another option that could have been elected.

B.

No contract may contain a provision that its benefits are excess or always secondary to any plan, except as allowed in parts 4685.0905 to 4685.0950.

Statutory Authority:

MS s 62D.08; 62D.182; 62D.20

History:

14 SR 901; 14 SR 2004

Published Electronically:

October 11, 2007