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Coordination of Benefits for Out-of-Country/Out-of-Province/Territory Medical Expenses

Release Date: 12/09/2013
Staff Reference: Joan Weir

Guideline G17

This Guideline describes how to coordinate the payments from all plans under which an individual is covered, and help ensure that the total payments from all plans do not exceed the total expenses incurred.

The intent is to provide for effective claims management; minimize claims assessment and payment delays; provide assistance to the Covered Individual in resolving the claim; fairly coordinate benefits among all plans involved; and identify and discourage duplicate or fraudulent claim submissions.