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4.5.4 Effect on the Benefits of This Plan. When This Plan is secondary, it may reduce its <br />benefits so that the total benefits paid or provided by all Plans during a claim determination <br />period are not more than the total Allowable Expenses In determining the amount to be <br />paid for any claim, the Secondary Plan must make payment in an amount so that, when <br />combined with the amount paid by the Primary Plan, the total benefits paid or provided by <br />all Plans for the claim equal one hundred percent of the total Allowable Expense for that <br />claim. Total Allowable Expense is the highest Allowable Expense of the Primary Plan or <br />the Secondary Plan. In addition, the Secondary Plan must credit to its Plan deductible any <br />amounts it would have credited to its deductible in the absence of other health care <br />coverage. <br />4.5.5 Right to Receive and Release Needed Information. Certain facts about dental care <br />coverage and services are needed to apply these COB rules and to determine benefits <br />payable under This Plan and other Plans The Participating Provider may get the facts it <br />needs from or give them to other organizations or persons for the purpose of applying these <br />rules and determining benefits payable under This Plan and other Plans covering the <br />person claiming benefits. The Participating Provider need not tell, or get the consent of, <br />any person to do this. Each person claiming benefits under This Plan must give the <br />Participating Provider any facts it needs to apply those rules and determine benefits <br />payable. <br />4.5.6 Facility of Payment. If payments that should have been made under This Plan are made <br />by another Plan, the issuer has the right, at its discretion, to remit to the other Plan the <br />amount it determines appropriate to satisfy the intent of this provision. The amounts paid <br />to the other Plan are considered benefits paid under This Plan. To the extent of such <br />payments, the issuer is fully discharged from liability under This Plan. <br />4.5.7 Right of Recovery. The issuer has the right to recover excess payment whenever it has <br />paid Allowable Expenses in excess of the maximum amount of payment necessary to <br />satisfy the intent of this provision. The issuer may recover excess payment from any <br />person to whom or for whom payment was made or from any other issuers or Plans. <br />4.5.8 If an Enrollee is covered by more than one Plan, and the Enrollee does not know which is <br />the Primary Plan, the Enrollee may contact any one of the Plans to verify which Plan is <br />primary. The Plan the Enrollee contacts is responsible for working with the other Plan to <br />determine which is primary and will let the Enrollee know within 30 days. Plans may have <br />timely claim filing requirements. If the Enrollee or provider fails to submit a claim to a <br />secondary Plan within that Plan's claim filing time limit, the Plan can deny the claim. If the <br />Enrollee experiences delays in the processing of a claim by the Primary Plan, the Enrollee <br />or provider will need to submit a claim to the Secondary Plan within its claim filing time limit <br />to prevent a denial of the claim To avoid delays in claims processing, if an Enrollee is <br />covered by more than one Plan, the Enrollee should promptly report to providers and Plans <br />any changes in coverage. <br />001 L-WA811(5/20) 12 <br />