(1) The purpose of these rules is to adopt the Model Group Coordination of Benefits Regulations, as promulgated by the National Association of Insurance Commissioners. These rules are intended to establish uniformity in the permissive use of overinsurance provisions and to avoid claim delays and misunderstandings that could otherwise result from the use of inconsistent or incompatible provisions among plans.

(2) A coordination of benefits (COB) provision is one that is intended to avoid claims payment delays and duplication of benefits when a person is covered by two or more plans providing benefits or services for medical, dental or other care or treatment. It avoids claims payment delays by establishing an order in which plans pay their claims and providing the authority for the orderly transfer of information needed to pay claims promptly. It avoids duplication of benefits by permitting a reduction of the benefits of a plan when, by these rules, it does not have to pay its benefits first.

(3) These rules permit, but do not require, plans to include COB provisions.

(4) If a group contract includes a COB provision, it must be consistent with these rules. A plan that does not include such a provision may not take the benefits of another plan as defined in subsection (1) of ARM 6.6.2403 into account when it determines its benefits. There is one exception: a contract holder's coverage that is designed to supplement a part of a basic package of benefits may provide that the supplementary coverage must be excess to any other parts of the plan provided by the contract holder.