When a claimant has coverage under more than one health plan, which provision applies?

The correct answer is Coordination of Benefits. This provision is specifically designed for situations where a claimant has coverage under multiple health plans. It establishes a systematic approach to determining which insurance plan will pay benefits first (the primary plan) and which will pay second (the secondary plan). This ensures that the total benefits paid to the claimant do not exceed the total allowable expenses incurred.

Coordination of Benefits is essential for preventing overpayments and ensuring a fair distribution of coverage among the various health plans. It helps streamline the claims process when a patient is covered by more than one insurer, clarifying the order of payment and minimizing confusion and disputes.

In contrast, other provisions like the Subrogation Clause, which allows an insurer to seek reimbursement from a third party responsible for a loss, do not specifically address situations involving multiple insurance policies. Primary vs Secondary Coverage is related to the concept of coordination, but it does not encompass the full framework that defines how benefits are coordinated between multiple plans. Benefit Limitations refer to the caps or restrictions placed on the amount that can be claimed under specific circumstances, but they do not pertain directly to the issue of having multiple insurance coverages.