Section R590-131-5 - Rules for Coordination of BenefitsWhen an enrollee is covered by more than one plan, the rules for determining the order of benefit payments are as follows:
(1) The primary plan shall pay or provide benefits as if a secondary plan does not exist.(2) If the primary plan is a closed panel plan and the secondary plan is not a closed panel plan, the secondary plan shall pay or provide benefits as the primary plan, except for an emergency service or an authorized referral that is paid by the primary plan.(3) If an enrollee is covered by more than one secondary plan, the order of benefits is determined using Section R590-131-6. (4)(a) Except as provided in Subsection (4)(b), a plan that does not contain a COB provision consistent with this rule is the primary plan unless both plans state that the conforming plan is primary.(b) Supplemental coverage that is obtained through membership in a group may be excess to a plan with a basic package of benefits.(i) Supplemental coverage includes:(A) major medical coverage that is superimposed over a base plan providing hospital and surgical expense benefits; and(B) insurance type coverage that is written in connection with a closed panel plan to provide out-of-network benefits.(ii) Supplemental coverage does not include a non-conforming plan.(5) Consideration of benefits paid or provided by another plan may only occur when the plan is secondary to the other plan.Utah Admin. Code R590-131-5
Amended by Utah State Bulletin Number 2020-15, effective 7/22/2020Amended by Utah State Bulletin Number 2022-17, effective 8/22/2022