Effect on Plan Benefits
If you have other health care coverage, the benefits payable under the Trust Preferred Provider and Indemnity Medical Plans (Regence), the Trust Dental Plan and the Trust Vision Plan may be reduced.
The Trust Medical and Dental Plans
If you have other health care coverage, the benefits payable under the Trust Preferred Provider and Indemnity Medical Plans (Regence) and the Trust Dental Plan may be reduced as follows:
-
If the other plan providing health care coverage does not have a coordination of benefit provision: The Trust Preferred Provider and Indemnity Medical Plans (Regence) and the Trust Dental Plan will reduce the amount it pays so that the amount paid under both plans does not exceed 100% of covered expenses. The benefits payable under each plan will be reduced proportionally to assure that benefits do not exceed the amount of the covered expenses.
-
If the other plan providing health care coverage has a coordination of benefits provision: The coordination of benefits provision will be followed to determine which plan pays secondary. If the Trust Preferred Provider or Indemnity Medical Plans (Regence) or the Trust Dental Plan pays secondary, it will not pay more than 100% of the allowed amount for the covered service. The Trust, however, will keep a record of the difference between what was paid and what would have been paid if the Trust Preferred Provider and Indemnity Medical Plans (Regence) or the Trust Dental Plan was the primary payer. These savings will be applied to other covered expenses you incur during the same calendar year. These savings cannot be used for expenses other than covered expenses under this plan and cannot be carried forward beyond the calendar year in which the savings were recognized.
The Trust Vision Plan
If you have other vision coverage, the benefits payable under the VSP Plan may be reduced, as follows:
-
If the other plan providing vision coverage does not have a coordination of benefit provision: The VSP plan will reduce the amount it pays so that the amount paid under both plans does not exceed 100% of covered expenses. The benefits payable under each plan will be reduced proportionally to assure that benefits do not exceed the amount of the covered expenses.
-
If the other plan providing vision coverage has a coordination of benefits provision: The coordination of benefits provision will be followed to determine which plan pays secondary. If the VSP plan pays secondary, it will not pay more than the amount of benefits it would have paid for the covered service or supply had it been the primary plan. VSP, however, will keep a record of the difference between what was paid and what would have been paid if VSP was the primary payer. These savings will be applied to other covered expenses you incur during the same calendar year. These savings cannot be used for expenses other than covered expenses under this plan and cannot be carried forward beyond the calendar year in which the savings were recognized.
|
