The purpose of the 'No-loss No-gain' provision is to avoid duplication of what when an individual is covered under multiple group health insurance plans?

The 'No-loss No-gain' provision serves a vital function in managing health insurance coverage for individuals insured under multiple group health plans. This provision is designed to prevent overinsurance, ensuring that when an individual submits claims for medical services, they do not receive a payout that exceeds the total cost of those services. Essentially, it helps coordinate benefits between different insurance plans to eliminate scenarios where one could profit from their health insurance, which would be the case if they received benefit payments that outstrip their actual medical expenses.

In situations where a person has coverage under more than one plan, the 'No-loss No-gain' provision ensures that their total payout can’t exceed the incurred medical expenses. This contrasting helps retain a level of integrity within the insurance system, as it allows individuals to cover their medical needs without allowing for any form of financial gain from their insurance claims. As a result, if multiple policies are activated, any payments made would be coordinated appropriately to cover the costs while avoiding duplicative benefit payments.

This mechanism is crucial in today’s landscape of health insurance, where many individuals find themselves enrolled in multiple plans, perhaps through their employer and a spouse’s policy. By adhering to this provision, insurance companies work harmoniously to ensure that individuals are adequately covered