Dual Coverage Restriction Clause Samples

The Dual Coverage Restriction clause limits or excludes insurance coverage when the same loss or claim is covered by more than one policy. In practice, this means that if an insured party has multiple insurance policies that could respond to a particular event, the clause will determine which policy is responsible or may prevent double recovery by the insured. This clause is designed to prevent overlapping payouts and ensure that the insured does not receive more than the actual loss, thereby allocating risk appropriately between insurers and maintaining fairness in claims settlements.
Dual Coverage Restriction. 5.4.1 In the event that a unit member and his/her spouse or domestic partner are both eligible to participate in the District’s health insurance plan(s), their participation shall be restricted to a single family coverage or two (2) individual coverages. In the event that a single family coverage is opted for, there shall be an entitlement to payment of a mandatory health insurance buy-out in the amount referenced in Paragraph 5.3.2, above. In the event of the death of the insured spouse or domestic partner after the time of retirement of both spouses or domestic partners from the District, the surviving spouse or domestic partner shall be entitled to individual or family coverage, if applicable, in the District’s plan(s). This provision shall apply to unit members during their years of retirement. 5.4.2 Notwithstanding the above, in the event that the dual coverage restriction would cause the District to be in a position to fail to offer health insurance coverage to at least 95% of the full-time employees in the bargaining unit (as defined in the Affordable Care Act or any successor federal legislation), one spouse shall be offered health coverage at the Article
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Dual Coverage Restriction. In the event that a unit member and his/her spouse are both eligible to participate in the District Health Insurance Plan(s), their participation shall be restricted to a single family coverage or two (2) individual coverages. In the event that a single family coverage is opted for, there shall be an entitlement to payment of a mandatory health insurance buy- out in the amount referenced in paragraph “3” below. In the event of the death of the insured spouse after the time of retirement of both spouses from the District, the surviving spouse shall be entitled to individual or family coverage, if applicable, in the District’s Plan(s).
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