15.3 COORDINATION OF BENEFITS (COB) AND DUPLICATE COVERAGE
How Duplicate Coverage Occurs
This section describes the circumstances when a Participant or Dependent may be entitled to benefits under this Plan and may also be entitled to recover all or part of their expenses from some other source. This section also describes the rules that apply when this happens, commonly referred to as “Coordination of Benefits.” All references to “Participants” regarding the Plan’s “Coordination of Benefits” refer equally to all persons covered by the Plan including Dependents.
There are several circumstances that may result in a Participant being reimbursed for expenses not only from this plan but also from another source. This can occur if, for example:
- A Participant is also covered by another group health care plan, or any group or individual insurance policy; or
- Both husband and wife or parent and child are covered under Alaska Teamster-Employer Welfare Trust; or
- A Participant is also covered by Medicare or some other government program, such as Medicaid, TRICARE, or a program of the U.S. Department of Veterans Affairs, coverage provided by a federal, state or local governmental agency, or coverage required by federal, state or local laws, such as (but not limited to) motor vehicle no-fault coverage for medical expenses or loss of earnings that is required by law; or
- A third party is responsible for the condition that occasioned medical need under any group or other insurance policy or arrangement. In this instance, refer also to the Subrogation and Reimbursement section of this Booklet for further information.