NDAC 45-08-01.2-05
Procedure to be followed by secondary plan to calculate benefits and pay a claim
Cite as N.D. Admin. Code ยง 45-08-01.2-05
In determining the amount to be paid by the secondary plan on a claim, should the plan wish to
coordinate benefits, the secondary plan shall calculate the benefits it would have paid on the claim in
the absence of other health care coverage and apply that calculated amount to any allowable expense
under its plan that is unpaid by the primary plan. The secondary plan may reduce its payment by the
amount so that, when combined with the amount paid by the primary plan, the total benefits paid or
provided by all plans for the claim do not exceed one hundred percent of the total allowable expense
for that claim. In addition, the secondary plan shall credit to its plan deductible any amounts it would
have credited to its deductible in the absence of other health care coverage.