Texas § IN.1203.052 - COORDINATION OF BENEFITS BETWEEN PRIMARY AND SECONDARY INSURERS

§ IN.1203.052. COORDINATION OF BENEFITS BETWEEN PRIMARY AND SECONDARY INSURERS

COORDINATION OF BENEFITS BETWEEN PRIMARY AND SECONDARY INSURERS. (a) This section applies if: (1) an insured is covered by at least two different insurance policies; and (2) each policy provides the insured dental benefits. (b) The primary insurer, as determined under a coordination of benefits provision applicable to the policies, is responsible for dental expenses covered under the insurance policy issued by the primary insurer up to the full amount of any policy limit applicable to the covered dental expenses. (c) Before the policy limit described by Subsection (b) is reached, the secondary insurer, as determined under a coordination of benefits provision applicable to the policies, is responsible only for dental expenses covered under the insurance policy issued by the secondary insurer that are not covered under the policy issued by the primary insurer. (d) After the policy limit described by Subsection (b) has been reached, the secondary insurer, in addition to the responsibility described by Subsection (c), is responsible for any dental expenses covered by both policies that exceed the policy limit described by Subsection (b), not to exceed the policy limit of the secondary policy. Added by Acts 2015, 84th Leg., R.S., Ch. 572 (H.B. 3024 ), Sec. 1, eff. September 1, 2015.