COORDINATION OF BENEFITS

In General

All medical and prescription drug benefits are subject to coordination. If you or your dependents are entitled to benefits under any other plan that will pay part or all of the expense incurred for treatment of sickness or injury, the benefits payable under this Plan and any other plans will be coordinated so that the aggregate amount paid will not exceed 100% of the expense incurred. In no event will the amount of benefits paid under this Plan exceed the amount that would have been paid if there were no other plan involved.

Benefits under this Plan will be coordinated with any group plan providing benefits or services for hospital or medical treatment that is: (a) group insurance coverage, (b) blanket insurance coverage that does not contain a nonduplication of benefits or excess policy provision, (c) group Blue Cross, Blue Shield, group practice and other prepayment coverage provided on a group basis, (d) any coverage under labor-management trusteed plans, union welfare plans, employer organization plans, or any other arrangement of benefits provided on a group basis; (e) any group coverage under governmental programs, and any group coverage required or provided by any statute, and (f) no-fault auto insurance.

Which Plan Pays First?

If both plans have a coordination of benefits provision, the plan that insures you as an active employee pays first. If you receive benefits as an active employee under one plan and as a retiree under another, the plan you have as an active employee pays first. If you are insured as an employee under two plans, the plan that has insured you longer is primary. If one plan does not have a coordination of benefits provision, that plan is always primary. A participant or qualified beneficiary is subject to this Plan’s rules even if the Plan is a secondary carrier. If a dependent child is covered under two plans, the plan of the parent whose birthday (month and day) is earlier in the year will pay its benefits first. If the parents of a dependent child are divorced or legally separated, the plan of the parent with custody of the child pays its benefits first. If the parent with custody remarries, the order of payment is as follows:

1. Natural parent with whom the child resides;
2. Stepparent with whom the child resides;
3. Natural parent not having custody of the child.

This order of payment can change if a court order specifically and unambiguously requires one of the parents to be financially responsible for the child’s medical expenses.

Special Rules Concerning Medicare

This Plan will pay benefits before Medicare in the following circumstances:

1. All claims for an active employee who is age 65 or older and who has not elected Medicare as primary carrier;
2. All claims for an active employee’s dependent spouse who is age 65 or older and who has not elected Medicare as primary carrier;
3. The first 30 months of treatment for end-stage renal disease received by any insured person who is less than age 65; and
4. All claims for an active employee or any dependent of any active employee who is totally and permanently disabled.

When these circumstances do not apply, this Plan will pay benefits only after Medicare has paid its benefits. This Plan will provide no medical coverage to an active employee age 65 or older or the spouse of an active employee age 65 or older who elects Medicare as primary carrier, as Medicare rules do not allow that option.