2026 CODAC Benefit Summaries and Carrier Flyers

COORDINATION OF BENEFITS

Coordination of Benefits (COB) applies whenever a Covered Person has health coverage under more than one Plan, as defined below. It does not, however, apply to Prescription benefits . The purpose of coordinating benefits is to help Covered Persons pay for Covered Expenses, but not to result in total benefits that are greater than the Covered Expenses Incurred. Covered Persons who are eligible for secondary coverage by any other health plan are encouraged to obtain such coverage. Failure to obtain secondary coverage may result in the Covered Person incurring costs, which are not covered by the Plan and which would otherwise be covered by the secondary coverage. The Plan will not pay for any costs which are payable by such secondary coverage when said coverage is primary, except to the extent that such costs are payable in any event by the Plan. The order of benefit determination rules determine which plan will pay first (which is the Primary Plan). The Primary Plan pays without regard to the possibility that another plan may cover some expenses. A Secondary Plan pays for Covered Expenses after the Primary Plan has processed the claim, and will reduce the benefits it pays so that the total payment between the Primary Plan and the Secondary Plan does not exceed the Covered Expenses Incurred. Up to 100% of charges Incurred may be paid between both plans.

The Plan will coordinate benefits with the following types of medical or dental plans:

Group health plans, whether insured or self-insured.

• •

Foreign health care coverage.

• Medical care components of group long-term care contracts, such as skilled nursing care. • Medical benefits under group or individual motor vehicle policies (including no-fault policies). See the order of benefit determination rules (below). • Medical benefits under homeowner’s insurance policies. • Medicare or other governmental benefits, as permitted by law, not including Medicaid. See below.

However, this Plan does not coordinate benefits with individual health or dental plans.

Each contract for coverage is considered a separate plan. If a plan has two parts and COB rules apply to only one of the two parts, each of the parts is treated as a separate plan. If a plan provides benefits in the form of services rather than cash payments, the reasonable cash value of each service rendered will be considered an allowable expense and a benefit paid. When this Plan is secondary, and when not in conflict with a Network contract requiring otherwise, covered charges will not include any amount that is not payable under the primary plan as a result of a contract between the primary plan and a Provider of service in which such Provider agrees to accept a reduced payment and not to bill the Covered Person for the difference between the Pr ovider’s contracted amount and the P rovider’s regular billed charge.

ORDER OF BENEFIT DETERMINATION RULES

The first of the following rules that apply to a Covered Person’s situation is the rule t hat will apply:

• The plan that has no coordination of benefits provision is considered primary.

• When medical payments are available under motor vehicle insurance (including no-fault policies), this Plan will always be considered secondary regardless of the i ndividual’s election under Personal Injury Protection (PIP) coverage with the auto carrier.

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