Coordination of benefits Coordination of benefits (COB) happens when you have health coverage through two or more groups (such as your employer and your spouse’s employer), and these two group health plans both pay a portion of your health care claims. The rules beginning under the “Who pays first” section determine which plan pays first (primary payer) and which pays second (secondary payer). See page 124 for a description of how the plan coordinates benefits when it pays second. The plan processes claims differently depending on if it is the primary payer or the secondary payer. The differences are described in the next several pages. TIP: If you have other health coverage, it is important that you let your providers know, including the pharmacies where you get your prescription drugs. Contact UMP and WSRxS If you or your dependents have other insurance, you must let UMP and WSRxS know so claims are processed correctly. To do this, you must complete and submit a separate form for medical services and prescription drugs. Each person claiming payment for benefits under the plan is required to give Regence and WSRxS any facts needed to apply these COB rules. If your coverage under other plans changes, you must let UMP and WSRxS know so claims are processed correctly. See the Directory pages at the beginning of this booklet for contact information and ways to get and submit COB forms. Who pays first Note: If you cannot determine which plan pays first, contact UMP Customer Service. Alert: Medicare will be the primary payer for covered benefits provided to Medicare-eligible members who are enrolled in UMP as a dependent of a currently employed state-registered domestic partner. Medicare will remain the secondary payer for benefits payable under UMP for (1) individuals age 65 or over who have UMP as a result of their own current employee status, or (2) individuals age 65 or over who have UMP as a result of the current employment status of a spouse of any age. When UMP coordinates benefits with other plans, the following rules determine which plan pays first. These rules apply in order, so the first rule below that applies to your situation will determine which plan is your primary coverage, and subsequent rules will not apply. The following plan pays first: • Any group plan that does not coordinate benefits. • The plan that covers the member as a subscriber, not a dependent. Exception: When the subscriber is a Medicare beneficiary, the plan covering the person as the retiree is secondary to the plan covering the person as a dependent. • The plan that covers the member (or their spouse or state-registered domestic partner) as an active employee pays before a plan that covers the member as a retired employee. 122 2024 UMP Classic (PEBB) Certificate of Coverage
UMP Classic COC (2024) Page 122 Page 124