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Guideline G17 - Co-ordination of Benefits for Out-of-Country/Out-of-Province/Territory Medical Expenses

This Guideline describes the coordination of payments from plans under which an individual is covered for out-of-country/out-of-province/territory medical expenses. Many of the processes outlined in the Guideline occur between insurers or plan administrators. The primary responsibility of the Covered Individual, once initial contact has been made with their insurer or plan administrator, is to disclose all sources of available coverage to facilitate the process between all potential payment sources.
Group InsuranceGroup Insurance guidelines and reference documentsCoordination of benefits
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.

Related Reference Documents:

Co-ordination of Benefits Examples: Out-of-Country/Out-of-Province/Territory Medical Expenses
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