Benefits Handbook

If you or an eligible family member has coverage under the Company healthcare benefits plans and coverage under another healthcare plan (such as a plan sponsored by your spouse's employer), the Company's benefits are "coordinated" with those provided by the other plan.

In addition to having your benefits coordinated with other group health plans, benefits from the Company healthcare plans are coordinated with "no fault" automobile insurance and any payments recoverable under any workers' compensation law, occupational disease law or similar legislation.

Coordination of benefits is what happens when a person is covered under more than one group plan.

You or a covered family member may be entitled to benefits under another group health plan (such as a plan sponsored by your spouse's employer) that pays part or all of your health treatment costs. If this is the case, benefits from the Company healthcare plan will be "coordinated" with the benefits from the other plan. In addition to having your benefits coordinated with other group health plans, benefits from the Company healthcare plan are coordinated with "no fault" automobile insurance and any payments recoverable under any worker's compensation law, occupational disease law or similar legislation.

When the Company healthcare plan is primary, it pays benefits first without consideration of the other plan. After you receive payment from the Company healthcare plan, you may then submit a claim to your secondary plan and possibly receive additional reimbursement. Reimbursement from your secondary plan depends on that plan's coverage levels and coordination of benefits rules. Reimbursements by both plans cannot exceed the full amount of covered expenses.

When you or your spouse is covered under two plans, there are certain rules that determine which plan pays its benefits first. The plan that covers you or your spouse as the employee pays its benefits before the plan that covers you or your spouse as a family member.

If it is determined that the other plan will pay first, the benefits payable under your Company healthcare plan will be reduced by the amount or value of the services paid by the other plan.

You should submit your claims to the primary plan first. When you receive a payment from the primary plan, you should submit a claim form and a copy of the Explanation of Benefits to the secondary payer, for any additional benefit.

The benefit plan of the parent whose birthday falls earlier in the calendar year pays first. If both parents have the same birthday, the plan that has covered the child(ren) longer pays first. If the other plan does not have the parent birthday rule, the other plan's coordination of benefits rule applies.

You should submit your claims to the primary plan first. When you receive a payment from the primary plan, you should submit a claim form and a copy of the Explanation of Benefits to the secondary payer, for any additional benefit.

The plan that pays first is decided in this order:

In the case of joint custody where there is no financial responsibility for a child's health care has been established by the court order, the plan of the parent whose birthday falls earlier in the year will pay first.

You should submit your claims to the primary plan first. When you receive a payment from the primary plan, you should submit a claim form and a copy of the Explanation of Benefits to the secondary payer, for any additional benefit.

If you are covered as the employee under two separate medical plans, the medical plan that has covered you for the longest time will be the primary plan and will pay its benefits first.

You should submit your claims to the primary plan first. When you receive a payment from the primary plan, you should submit a claim form and a copy of the Explanation of Benefits to the secondary payer, for any additional benefit.

If you become disabled and qualify for Medicare while on long term disability, you must sign up for Medicare Parts A and B. If you are enrolled in a Company medical plan, Medicare will be the primary plan and your Company medical plan coverage will be the secondary plan. The Company plan will pay as if it is secondary even if you fail to sign up for Medicare.

You should submit your claims to the primary plan first. When you receive a payment from the primary plan, you should submit a claim form and a copy of the Explanation of Benefits to the secondary payer, for any additional benefit.

If you are disabled and qualify for Medicare, your family member(s) will continue their primary plan coverage under the Company medical plan.

If you are disabled and qualify for Medicare and your family member is deemed to be Medicare-eligible (e.g., disabled, attains age 65) your family member(s) must sign up for Medicare Parts A and B.

While you are in active employment, your Company medical plan is your primary plan, even if your family member is eligible for Medicare. If your family member is enrolled in Medicare, Medicare becomes the secondary plan for that family member.

In general, Medicare doesn't provide dental coverage.

But if there is an expense that both the Dental Plan and Medicare cover, the Dental Plan will pay benefits before Medicare.

To the maximum extent permitted by law, the Plan is entitled to equitable or other permitted remedies, including a lien or constructive trust, to recover any amounts received as a result of a judgment, settlement or other means of compensation for conditions or injuries which have resulted in the payment of benefits under this Plan. This will include, but is not limited to, damages for pain and suffering and lost income.

The Plan is entitled to recover these amounts from you, as the employee, any covered family member or beneficiary, or any other person holding them, up to the amount of all payments made or payable in the future plus the costs of recovery. The Plan has a priority interest in any and all funds recovered in any full or partial recovery, including funds intended to compensate for attorney's fees and other expenses.

As a condition of receiving benefits under this Plan, you agree that: