- 10 - Prior to and throughout the years in issue, for financial statement and Annual Statement reporting purposes, and in calculations of its financial loss reserves, Blue Cross subtracted COB savings in its calculations of its unpaid losses. Blue Cross therefore maintained financial reserves relating to unpaid losses only for its estimated primary and secondary payment responsibilities due on claims after primary insurers had made their primary payments. In other words, Blue Cross did not maintain financial reserves with respect to its COB savings amounts. Prior to and throughout the years in issue, Blue Cross also included language in its health insurance plans that entitled Blue Cross to recovery or subrogation of amounts Blue Cross had paid on claims (1) where the injury was caused by third-party tortfeasers or (2) where, under the COB provisions, the amounts should have been paid by other health insurance companies. Such amounts received from tortfeasers and from other health insurance companies are treated and referred to by insurance companies as “subrogation recoverable”. The COB guidelines promulgated by the National Association of Insurance Commissioners treat COB savings differently from subrogation recoverable. Blue Cross also treats COB savings differently from subrogation recoverable, and Blue Cross maintains separate departments for each.Page: Previous 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Next
Last modified: May 25, 2011