MTABF
MAHOPAC TEACHERS ASSOCIATION BENEFIT FUND
Post Office Box # 656
Baldwin Place, NY 10505
Phone: 845.543.7415
Post Office Box # 656
Baldwin Place, NY 10505
Phone: 845.543.7415
GUIDE TO COORDINATION OF BENEFITS
In general, when benefits would be payable under more than one Group Plan, benefits payable under those plans will be coordinated to the extent that the total benefits under all Group Plans will not exceed 100% of the total allowable expenses. "Allowable expense" means any necessary, reasonable and customary expense that is covered in whole or in part under at least one of these Group Plans.
Claim Procedures under the Coordination of Benefits Provision:
If you are a covered member of the Fund, and are eligible for benefits from another Group Plan:
In general, when benefits would be payable under more than one Group Plan, benefits payable under those plans will be coordinated to the extent that the total benefits under all Group Plans will not exceed 100% of the total allowable expenses. "Allowable expense" means any necessary, reasonable and customary expense that is covered in whole or in part under at least one of these Group Plans.
Claim Procedures under the Coordination of Benefits Provision:
If you are a covered member of the Fund, and are eligible for benefits from another Group Plan:
- Submit your claim to the Fund Office.
- After you have received payment for such claim from the Fund, you may submit this claim to the other Group Plan under which you are eligible for benefits.
- You will receive any additional benefits, which may be due for this claim under the second plan, but the total amount you receive for each claim from this Fund and from any other Group Plan cannot exceed 100% of allowable expenses.
- If your spouse has a claim and is eligible for benefits under another Group Plan:
- He/she must submit the claim to his/her plan first.
- After this claim is paid by that plan, it may be submitted to this Fund accompanied by an explanation of benefits received from the other plan.
- Any additional benefits, which may be due for this claim, will be paid by this Fund, but the total amount paid for this claim from this Plan will not exceed 100% of allowable expenses as determined by the Fund.
- He/she must submit the claim to his/her plan first.
- If a claim is submitted for a child when one parent is a covered member of this Fund, and the other parent is a covered member of another plan:
- Submit this claim to the Plan of the parent whose birthday (month and day only) occurs first in a calendar year.
- After the claim has been paid by the first plan, it may be submitted to the second plan along with an explanation of benefits received from the first plan.
- The payment you receive for each claim from both plans cannot exceed 100% of allowable expenses.
- Submit this claim to the Plan of the parent whose birthday (month and day only) occurs first in a calendar year.
- If the claim is submitted for a child whose parents are divorced when one parent is a covered member of this Fund and the other parent is a covered member of another plan:
- If the parent with custody has not remarried
- Submit the claim to the Plan that covers the parent with custody first.
- After the claim has been paid by the first plan when it may be submitted to the second plan along with another explanation of benefits received from the first plan.
- If the parent with custody has not remarried
- If the parent with custody has remarried
- Submit the claim to the plan that covers the parent with custody first.
- Submit to the plan that covers the stepparent second.
- Submit the claim to the plan that covers the parent without custody last.
- Submit the claim to the plan that covers the parent with custody first.
- In the event there is a court order that establishes financial responsibility for the medical, dental or other health care expenses of the child, submit the claim to the Plan that covers the parent with the court-ordered responsibility first