After group health coverage under the Contract ends, the former spouse and any children covered under the individual contract may still receive benefits under the Contract. If so, benefits to be paid under the individual contract, if any, will be reduced by the amount paid or the reasonable cash value of services provided under the Contract.] MEDICARE AS SECONDARY PAYOR IMPORTANT NOTICE The following sections regarding Medicare may not apply to the Employer's Contract. The Employee must contact his or her Employer to find out if the Employer is subject to Medicare as Secondary Payor rules. If the Employer is subject to such rules, this Medicare as Secondary Payor section applies to the Employee. If the Employer is NOT subject to such rules, this Medicare as Secondary Payor section does not apply to the Employee, in which case, Medicare will be the primary health plan and the Contract will be the secondary health plan for [Members] who are eligible for Medicare. Benefits will be payable as specified in the COORDINATION OF BENEFITS AND SERVICES section of the Contract. The following provisions explain how the Contract’s group health benefits interact with the benefits available under Medicare as Secondary Payor rules. A [Member] may be eligible for Medicare by reason of age, disability, or End Stage Renal Disease. Different rules apply to each type of Medicare eligibility, as explained below. With respect to the following provisions: "Medicare" when used above, means Part A and B of the health care program for the aged and disabled provided by Title XVIII of the United States Social Security Act, as amended from time to time. A [Member] is considered to be eligible for Medicare by reason of age from the first day of the month during which he or she reaches age 65. However, if the [Member] is born on the first day of a month, he or she is considered to be eligible for Medicare from the first day of the month which is immediately prior to his or her 65th birthday. A "primary" health plan pays benefits for a [Member’s] Covered Service or Supply or Covered Charge first, ignoring what the [Member’s] "secondary" plan pays. A "secondary" health plan then pays the remaining unpaid allowable expenses. See the COORDINATION OF BENEFITS AND SERVICES section for a definition of "allowable expense". MEDICARE ELIGIBILITY BY REASON OF AGE (Generally applies to employer groups with 20 or more employees) Applicability
After group health coverage under the Contract ends, the former spouse and any children covered under the individual contract may still receive benefits under the Contract. If so, benefits to be paid under the individual contract, if any, will be reduced by the amount paid or the reasonable cash value of services provided under the Contract.] MEDICARE AS SECONDARY PAYOR IMPORTANT NOTICE The following sections regarding Medicare may not apply to the Employer's Contract. The Employee must contact his or her Employer to find out if the Employer is subject to Medicare as Secondary Payor rules. If the Employer is subject to such rules, this Medicare as Secondary Payor section applies to the Employee. If the Employer is NOT subject to such rules, this Medicare as Secondary Payor section does not apply to the Employee, in which case, Medicare will be the primary health plan and the Contract will be the secondary health plan for [Members] who are eligible for Medicare. Benefits will be payable as specified in the COORDINATION OF BENEFITS AND SERVICES section of the Contract. The following provisions explain how the Contract’s group health benefits interact with the benefits available under Medicare as Secondary Payor rules. A [Member] may be eligible for Medicare by reason of age, disability, or End Stage Renal Disease. Different rules apply to each type of Medicare eligibility, as explained below. With respect to the following provisions: "Medicare" when used above, means Part A and B of the health care program for the aged and disabled provided by Title XVIII of the United States Social Security Act, as amended from time to time. A [Member] is considered to be eligible for Medicare by reason of age from the first day of the month during which he or she reaches age 65. However, if the [Member] is born on the first day of a month, he or she is considered to be eligible for Medicare from the first day of the month which is immediately prior to his or her 65th birthday. A "primary" health plan pays benefits for a [Member’s] Covered Service or Supply or Covered Charge first, ignoring what the [Member’s] "secondary" plan pays. A "secondary" health plan then pays the remaining unpaid allowable expenses. See the COORDINATION OF BENEFITS AND SERVICES section for a definition of "allowable expense". MEDICARE ELIGIBILITY BY REASON OF AGE (Generally applies to employer groups with 20 or more employees) Applicability