18 Del. Admin. Code § 1307-4.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 1307-4.0 - Model Cob Contract Provision

4.1 General

4.1.1 Appendix A contains a model COB provision for use in group contracts. That use is subject to the provisions of sections 4.2, 4.3 and 5.0.

4.2 Flexibility

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

4.3 Prohibited Coordination and Benefit Design.

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

4.3.1.1 Another plan exists;

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

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

4.3.2 No contract may contain a provision that its benefits are "excess" or "always secondary" to any plan as defined in this regulation, except in accord with the rules permitted by this regulation.

18 Del. Admin. Code § 1307-4.0

10 DE Reg. 1828 (06/01/07)