The following words and terms, when used in this regulation, shall have the following meanings, unless the context clearly indicates otherwise.

1. (1) Allowable expense--The necessary, reasonable, and customary item of expense for health care when the item of expense is covered at least in part under any of the plans involved, except where a statute requires a different definition.
2. (2) Claim--A request that benefits be provided or paid. The benefits claimed may be in the form of services (including supplies); payment for all or a portion of the expenses incurred; a combination of services and payment of expenses; or an indemnification.
3. (3) Claim determination period--The period of time, which must not be less than 12 consecutive months, over which allowable expenses are compared with total benefits payable in the absence of a coordination of benefits to determine whether overinsurance exists and how much each plan will pay or provide.
4. (4) Coordination of benefits (COB)--A provision establishing an order in which plans pay their claims.
5. (5) Group-type contracts--The contracts described in §3.3506 of this title (relating to Use of the Terms "Plan," "Primary Plan," "Secondary Plan," and "This Plan" in Policies, Certificates, and Contracts).
6. (6) Hospital indemnity benefits--Benefits not related to expenses incurred. This term does not include reimbursement-type benefits even if they are designed or administered to give the insured the right to elect indemnity-type benefits at the time of claim.
7. (7) Insurer--An entity authorized under the Insurance Code to provide group or group-type accident or health coverage, including an insurance company, a group hospital service corporation authorized under the Insurance Code, Chapter 20, or a stipulated premium company under the Insurance Code, Chapter 22.
8. (8) Plan--A form of coverage with which coordination is allowed. Provisions relating to the proper use in policies of the terms "plan," "primary plan," "secondary plan," and "this plan" are found at §3.3506 of this title (relating to Use of the Terms "Plan," "Primary Plan," "Secondary Plan," and "This Plan" in Policies, Certificates, and Contacts).

Source Note:The provisions of this §3.3503 adopted to be effective June 3, 1994, 19 TexReg 3938.