In some cases, a court order determines payment for health care expenses. In those cases, standard COB rules may not apply. You must promptly provide the plan with copies of the court order for the plan to determine which plan pays first. If a dependent child is covered under more than one plan through persons who are not the child’s parent or stepparent (e.g., a grandparent or other guardian), the plan will use the birthday rule to determine which plan pays first. If none of the preceding rules determine who pays first, then each plan covers half of the allowed expenses. Federal and military plans UMP usually pays first over certain federal or military programs for veterans (retired military members). When UMP pays first When the plan is the primary payer (pays first), UMP pays its normal benefit as described in this COC. You may need to send UMP’s Explanation of Benefits and a copy of your provider’s bill to your secondary payer to receive payment. Check with that plan for more information. When UMP is supposed to pay first, but another plan did instead If another plan pays first on claims where UMP should have paid first: • UMP may pay the other plan the amount UMP should have paid. • Amounts UMP pays to the other plan are considered benefits paid by UMP. How UMP coordinates benefits when it pays second FOR MEDICARE RETIREES: For more detail on how Medicare and UMP Classic interact when Medicare pays first, and UMP Classic pays second, see page 128. UMP uses a type of COB called nonduplication of benefits (see definition of “Nonduplication of benefits”). When UMP pays second to another plan that covers the member, UMP will pay only an amount needed to bring the total benefit up to the amount UMP would have paid if the member did not have another plan. The intent of this type of COB is to maintain the level of benefits available through UMP. The nonduplication of benefits type of coordination is not designed to pay your covered expenses in full. When UMP pays second, it coordinates with these types of plans: • Governmental programs including, but not limited to, Medicare and Medicaid. • Group, blanket, or franchise health or disability insurance policies; health care service contractor and health maintenance organization group agreements issued by insurers; health care service contractors; and health maintenance organizations. • Labor management trusteed plans, labor organization plans, employer plans, or employee benefit organization plans. ALERT! If you have other primary coverage that pays for services, those services will apply to the UMP benefit limit. 124 2024 UMP Classic (PEBB) Certificate of Coverage