BOILERPLATE
Language which is used commonly in documents having a definite meaning in the same context without variation; used to describe standard language in a legal document that is identical in instruments of a like nature.

COORDINATION OF BENEFITS (COB)
 A provision in a contract that applies when a person is covered under more than one group medical program. It requires that payment of benefits will be coordinated by all programs to eliminate overinsurance or duplication of benefits.

COVERED SERVICES
 The defined services required by contract to be provided to members. Exclusions, conditions and other provisions can effect the definition of what are “Covered Servies.” See earlier classes.

GENERIC DRUG
 A chemically equivalent copy designed from a brand-name drug that has an expired patent. A generic is typically less expensive and sold under a common or “generic” name for that drug, not the name brand (ex. the brand name for one tranquilizer is Valium, but it is also available under the generic name diazepam). Also called generic equivalents.

HOLD HARMLESS
 A provision in a contract such as between a hospital and an HMO in which the hospital agrees to hold the members of the HMO harmless for paying for any Covered Services. This means that the hospital will not bill, charge, demand payment in any manner from the HMO members for such Covered Services.

SUBROGATION
 The contractual right of a health plan to recover payments made to a member for health care costs after a member has received such payment for damages in a legal action. A procedure under which an insurance company can recover from third parties the full or some proportionate part of benefits paid to an insured. For example, should a claimant who has received benefits under a state’s statutory plan covering disability benefits enter into litigation or make a claim against a third party, the insurance carrier has a right to place a lien against any benefit the third party action may provide.

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