(a) "Plan" means any plan providing benefits or services for or on account of medical or dental care or treatment, which benefits or services are provided by: - (i) group, blanket or franchise insurance coverage;
- (ii) service plan contracts, group practice, individual practice and other prepayment coverage;
- (iii) any coverage under labor-management trusteed plans, union welfare plans, employer organization plans, or employee benefit organization plans; and
- (iv) any coverage under government programs, and any coverage required or provided by statute.
(b) The term "Plan" shall be construed separately with respect to each policy, contract, or other arrangement for benefits or services and separately with respect to that portion of any such policy, contract, or other arrangement which reserves the right to take the benefits or services of other plans into consideration in determining its benefits and that portion which does not.
(c) The definition of a "Plan" within the COB provision of group contract shall enumerate the types of coverage which the insurer may consider in determining whether overinsurance exists with respect to a specific claim. Such definition: - (i) Shall not include individual or family policies, or individual or family subscriber contracts, except as provided in this subsection.
- (ii) May include all group policies or group subscriber contracts as well as such group-type contracts as are not available to the general public and can be obtained and maintained only because of the covered person's membership in or connection with a particular organization or group. Such group-type contracts may be included in the definition, at the option of the insurer, whether or not individual policy forms are utilized and whether the group-type coverage is designated as "franchise" or "blanket' or in some other fashion.
- (iii) Shall not include group or group-type hospital indemnity benefits written on a non-expense incurred basis unless they are characterized as reimbursement type benefits and are designed or administered so as to give the insured the right to elect indemnity type benefits, in lieu of such reimbursement type benefits, at the time of claim.
- (iv) School accident type coverages written on either an individual, group, blanket, or franchise basis shall not be taken into consideration in coordination of benefits.
- (v) If "Medicare" or similar governmental benefits are included in the definition of a "Plan," such benefits shall be considered without expanding any of the definitions of this provision beyond the hospital, medical, and surgical benefits as may be provided by the governmental program.
- (vi) A plan may not coordinate or design benefits so that the benefits payable are altered solely on the basis that:
- (A) another plan exists; or
- (B) the claimant is or could have been covered under another plan; or
- (C) the claimant has elected an option under another plan providing a lower level of benefits than another option for which the claimant was eligible.
- (vii) Shall not include any policy providing coverage for a specified disease.
(d) "Allowable Expense" means any necessary, reasonable and customary item of expense at least a portion of which is covered under at least one of the plans covering the person for whom claim is made.
(e) When a plan provides benefits in the form of services rather than cash payments, the reasonable cash value of each service rendered shall be deemed to be both an allowable expense and a benefit paid.
044-10 Wyo. Code R. § 10-5