Schedule L Coordination of Benefits.docx
DOCX document 16 KB Posted
- Attached to
- MPSERS Dental Benefit Plan Administration
- Solicitation number
- RFP 171 200000001290 3
- Issued by
- Michigan
About this file
This is a Schedule L document from the State of Michigan outlining coordination of benefits provisions for health insurance plans under RFP No. 200000001290, governed by the Public School Employees Retirement Act (PA 300 of 1980). The document specifies requirements for hospital, medical-surgical, sick care, dental, and vision benefit plans that cover retirees, retirement allowance beneficiaries, and health insurance dependents. The coordination of benefits provisions establish a hierarchical approach to benefit determination when covered individuals are eligible for multiple insurance plans.
The coordination of benefits framework requires that Medicare or Medicaid benefits be determined first if a covered person is eligible for either program before the primary plan's benefits are calculated. When a covered person has dual coverage under another plan containing a coordination of benefits provision, benefits must be coordinated according to the Coordination of Benefits Act (1984 PA 64, MCL 550.251 to 550.255). If the secondary plan lacks a coordination of benefits provision, that plan's benefits are determined before the primary plan's benefits are applied. These provisions ensure proper benefit sequencing and prevent duplicate benefit payments across multiple insurance carriers.
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Text version
STATE OF MICHIGAN
RFP No. 200000001290
SCHEDULE L
Coordination of Benefits
The Public School Employees Retirement Act (PA 300 of 1980)
Section 38.1391 Sec. 91
13) The hospital, medical-surgical, and sick care benefits plan, dental plan, and vision plan that covers retirants, retirement allowance beneficiaries, and health insurance dependents pursuant to this section shall contain a coordination of benefits provision that provides all of the following:
a) If the person covered under the hospital, medical-surgical, and sick care benefits plan is also eligible for medicare or medicaid, or both, then the benefits under medicare or medicaid, or both, shall be determined before the benefits of the hospital, medical-surgical, and sick care benefits plan provided pursuant to this section.
b) If the person covered under any of the plans provided by this section is also covered under another plan that contains a coordination of benefits provision, the benefits shall be coordinated as provided by the coordination of benefits act, 1984 PA 64, MCL 550.251 to 550.255.
c) If the person covered under any of the plans provided by this section is also covered under another plan that does not contain a coordination of benefits provision, the benefits under the other plan shall be determined before the benefits of the plan provided pursuant to this section.
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