Opinion ID: 453346
Heading Depth: 2
Heading Rank: 2

Heading: Relevant Terms of the Plans

Text: 8 Both the ILGWU and the Teamsters plans have other insurance clauses providing for situations in which a participant or beneficiary is covered by another insurance policy or plan. Specifically, each plan has a coordination of benefits (COB) section that sets out when the plan intends to be the primary insurer of a participant or beneficiary and when it intends to be a secondary or excess insurer. See infra notes 9 & 10. The Teamsters Fund's COB provision states that a[nother] plan covering the patient directly, rather than as an employee's dependent, is primary. The ILGWU Fund COB provision does not apply to the situation in which a participant is also a potential beneficiary of a spouse's plan. Instead, the ILGWU plan has a separate section labeled Exception to Eligibility, which states: 9 Exception to Eligibility--You are not eligible for hospital, medical-surgical, or Major Medical benefits under this plan if there exists at your spouse's place of employment a group plan which provides for family coverage of these types of benefits so long as 50% or more of the cost of such family coverage is paid for by other than you or a member of your family. 10 Id. at 54a. The Teamsters plan does not have any provision comparable to the ILGWU plan's Exception to Eligibility clause.