If a person is covered under more than one plan, the plans could pay benefits for more than 100% of the covered charges under the plans. To prevent benefit payments exceeding this Plan's allowable benefits, the Coordination of Benefits (COB) provision is included. It coordinates all the benefits provided by this Plan with similar benefits payable under any other medical plan. There are instances when a Covered Person may have more than one primary or more than one secondary insurance coverage. In that situation, first payment will be made by the older plan. In other words, the plan you have been covered under longer is your first primary.

In this section, the term "plan" means any health care coverage or similar arrangement which provides medical, dental, vision, or prescription care benefits on an insured or uninsured basis. It includes, but is not limited to:

1. group or blanket insurance;
2. Hospital or medical service pre-payment plans;
3. any coverage under Labor-Management-Trustee Plans, union welfare plans, employer organization plans, or employee benefit organization's plans;
4. any government programs;
5. any coverage required or provided by law;
6. "No Fault" auto insurance;
7. motor vehicle accidents. (See paragraph under Motor Vehicle Accidents.); and
8. any other reimbursement or settlement will always be investigated first including, but not limited to, Homeowner's policy, school policy or store liability. (See paragraphs entitled Subrogation and Third Party Liability.)

Each policy, contract, or other plan for benefits or services will be considered a separate plan. A plan may include a Coordination of Benefits provision (or similar provision) on some, but not all, of its benefits or services. The benefits or services subject to the Coordination of Benefits provision will be considered a separate plan from the benefits or services not subject to a Coordination of Benefits provision.

In this section, the term "allowable expense" means any Usual and Customary charge covered in full or in part under more than one plan. When this Plan is secondary (i.e., when this Plan pays after the benefits of another plan), "allowable expense" will include any Deductible or co-insurance amounts not paid by the other plan. No more than 100% of allowable expenses will be paid by all plans together. In no event will an "allowable expense" include an expense incurred when the person's coverage is not in effect under this Plan. When a plan provides benefits in the form of services, rather than cash payments, the reasonable cash value of the services will be considered a benefit paid.

COORDINATION PROCEDURES: If a Covered Person is covered under more than one plan, this Coordination of Benefits section will apply. This section will be used to determine the amount of benefits payable under this Plan for a Covered Person for any calendar year.

One plan is the primary plan, and all the other plans are secondary, in the order described below. The primary plan pays its benefits first, without taking the other plans into consideration. The secondary plans then pay benefits up to the extent of their liability, after taking into consideration the benefits provided by the other plans. This also applies to your prescription card. If this Plan is secondary for a Covered Person, you must submit your prescriptions to Phillips Administrative Service, Inc., for reimbursement of your Co-pay. Benefits under other plans include benefits which a Covered Person could have received if such benefits had been claimed.

1. If a plan has no Coordination of Benefits provision (or similar provision), it is automatically the primary plan.
2. If all the plans have Coordination of Benefits provisions, a plan is primary if it covers the person as an Employee, and secondary if it covers the person as a Dependent.
3. A plan is primary if it covers a person as an active Employee or a Dependent of an active Employee, and secondary if it covers a person as a retired Employee or a Dependent of a retired Employee.
4. If a person is covered as a Dependent child under more than one plan:
(a) the plan of the parent whose birthday falls earlier in the year is the primary plan;
(b) if the father and mother have the same birthday, the plan covering the parent longer is the primary plan;
(c) if the other plan coordinates benefits based upon the sex of the parents, then the plan that covers such person as a Dependent of a male person is the primary plan;
(d) if the parents are separated or divorced, the rules below will apply: (i) the plan covering the child as a Dependent of the parent with legal Custody of the child would be the primary plan; unless
(ii) a court decree sets the obligation for medical expenses of such child. The plan which covers the child as a Dependent of the parent with such obligation will be the primary plan.
(iii) if the non-custodial parent has Dependent insurance coverage, it must be primary over the step-parent's Dependent insurance for the step-child (when said step-parent is the Covered Employee under this Plan).
5. If a plan is "No Fault" auto insurance, it is the primary plan.
6. If the primary plan is still not established by (1), (2), (3), (4), or (5), then the plan that covers such person for the longest, continuous period of time will be the primary plan.
7. Auto Insurance liability will always be investigated first when applicable. (See paragraph entitled Motor Vehicle Accidents.)

(In the case of conflicting information, your Schedule of Benefits takes precedence.)

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