58-18A-78. Noncomplying secondary plan to advance difference covered person would have received if complying plan had been secondary plan.
154 words·~1 min read·
/sd/title-58/chapter-58-18/58-18a-78·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
If the noncomplying plan reduces its benefits so that the covered person receives less in benefits than the covered person would have received had the complying plan paid or provided its benefits as the secondary plan and the noncomplying plan paid or provided its benefits as the primary plan, then the complying plan shall advance to the covered person or on behalf of the covered person an amount equal to the difference.
In no event may the complying plan advance more than the complying plan would have paid had it been the primary plan less any amount it previously paid for the same expense or service. In consideration of the advance, the complying plan shall be subrogated to all rights of the covered person against the noncomplying plan. The advance by the complying plan shall also be without prejudice to any claim it may have against a noncomplying plan in the absence of subrogation.