When UMP Classic pays first and Medicare pays second If UMP Classic pays first and Medicare pays second, make sure that you tell Medicare about your UMP Classic coverage and that your provider agrees to bill Medicare as secondary to get the maximum benefit from both plans. Medicare generally accepts claims only from providers, so you may not be able to send a claim to Medicare for secondary payment. The provider would need to bill Medicare after UMP Classic has processed the claim. Note: Medicare accepts claims directly from members only under certain circumstances. FOR MEDICARE RETIREES: UMP Classic does not bill Medicare or in any way coordinate benefits with Medicare when Medicare is the secondary payer. When Medicare pays first and UMP Classic pays second UMP Classic and Medicare are two separate health plans that work together to pay for covered services and supplies. Here is how coordination of benefits works: • Your providers bill Medicare. Medicare pays your claims first. After Medicare processes the claim, Medicare sends the claim to UMP Classic. • UMP Classic pays your claims second. For most covered services, UMP Classic pays the rest of the Medicare allowed amount and you owe $0. Each calendar year, you must meet your UMP Classic medical deductible before UMP Classic starts paying benefits. If you receive more covered services during the same calendar year, you may be reimbursed for at least some of your UMP Classic deductible. That reimbursement will come from the COB savings. This savings is the part of your UMP benefit saved because Medicare pays part of your claims. See the “Why you might get a COB savings check from UMP Classic” section. Note: Services apply to the UMP medical deductible in the order claims are received, not necessarily in the order the member receives the services. Paying your UMP Classic and Medicare deductibles If you meet your UMP Classic deductible, you do not pay both the Medicare Part B and your UMP Classic deductible. Your Part B deductible is a part of the same total calendar year expenses processed by UMP Classic. An example is below. This example assumes you received care from a provider who accepts Medicare (has not “opted out” of Medicare) anywhere in the U.S. Benefit calculation Amount Medicare allowed amount $600 Medicare deductible $183 Subtract Medicare deductible from allowed amount: $600 - $183 = $417 Medicare pays 80% of this amount (0.80 x $417) = $333.60 Balance remaining after Medicare pays: $600 - $333.60 = $266.40 UMP Classic allowed amount $600 UMP Classic deductible $250 Subtract UMP Classic deductible from allowed amount: $600 - $250 = $350 Normal UMP Classic benefit (85% of this amount) (0.85 x $350) = $297.50 128 2024 UMP Classic (PEBB) Certificate of Coverage