§ 36-6931 — Coordination of benefits provisions.

A. A health maintenance organization is permitted, but not required, to adopt coordination of benefits provisions to avoid over insurance and to provide for the orderly payment of claims when an enrollee is covered by two or more group health insurance or health care plans. B. If a health maintenance organization adopts coordination of benefits, the provisions thereof shall be consistent with the coordination of benefits provisions that are in general use in the state for coordinating coverage between two or more group health insurance or health care plans. C. To the extent necessary for a health maintenance organization to meet its obligations as a secondary carrier under the rules for coordination, a health maintenance organization may make payments for services that are: 1. Received from nonparticipating providers; 2. Provided outside its service areas; or 3. Not covered under the terms of its group contract or evidence of coverage.

Legislative History

Added by Laws 2003, c. 197, § 31, eff. Nov. 1, 2003.