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- Alaska Statutes.
- Title 21. Insurance
- Chapter 51. Health Insurance Policies
- Section 200. Insurance With Other Insurers Providing Benefits For Loss On a Provision of Service or Expense Incurred Basis.
previous: Section 190
. Other Insurance in This Insurer.
next: Section 210
. Insurance With Other Insurers Providing Benefits For Loss On Other Than An Expense Incurred Basis.
AS 21.51.200. Insurance With Other Insurers Providing Benefits For Loss On a Provision of Service or Expense Incurred Basis.
- (a) There may be a provision as follows:
"Insurance With Other Insurers: If there is other valid coverage, not with this insurer, providing benefits for the
same loss on a provision of service basis or on an expense incurred basis and of which this insurer has not been given
written notice before the occurrence or commencement of loss, the only liability under an expense incurred coverage of
this policy shall be for the proportion of the loss that the amount that would otherwise have been payable hereunder
plus the total of the like amounts under all the other valid coverages for the same loss of which this insurer had
notice bears to the total like amounts under all valid coverages for the loss and for the return of the portion of the
premiums paid that exceed the pro rata portion for the amount so determined. For the purpose of applying this
provision when other coverage is on a provision of service basis, the "like amount' of the other coverage shall be
taken as the amount which the services rendered would have cost in the absence of the coverage."
- (b) If the policy provision in (a) of this section is included in a policy that also contains the policy provision set out
in AS 21.51.210
there shall be added to the caption of the foregoing provision the phrase " - Expense Incurred Benefits." The insurer
may, at its option, include in this provision a definition of "other valid coverage," approved as to form by the
director, which definition shall be limited in subject matter to coverage provided by organizations subject to
regulation by insurance law or by insurance authorities of this or any other state of the United States or a province
of Canada, and by hospital or medical service organizations, and to any other coverage the inclusion of which may be
approved by the director. In the absence of this definition the term may not include group insurance, automobile
medical payments insurance, or coverage provided by hospital or medical service organizations or by union welfare plans
or employer or employee benefit organizations. For the purpose of applying the foregoing policy provision with respect
to an insured, an amount of benefit provided for the insured under a compulsory benefit statute (including a workers'
compensation or employer's liability statute), whether provided by a governmental agency or otherwise, shall in all
cases be considered to be "other valid coverage" of which the insurer has had notice. In applying the foregoing policy
provision no third-party liability coverage shall be included as "other valid coverage."
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