15.11 COORDINATION WITH MEDICARE COVERAGE – WHO PAYS FIRST
Coverage Under The Plan and Medicare When You or Your Eligible Dependent is Age 65 or Older
If you are an Eligible Employee and you or your Dependent are entitled to Medicare as a result of being age 65 or older, coordination with Medicare rules will occur under the rules and procedures specified in your TEAMStar Booklet.
Coverage Under The Plan and Medicare When You are Totally Disabled
If you become Totally Disabled and entitled to Medicare because of your disability, you will no longer be considered actively employed. As a result, once you become entitled to Medicare because of your disability, Medicare pays first and this Plan pays second. If your Dependent becomes entitled to Medicare because of a disability, whether Medicare or the Plan pays first will depend on your current employment status. If you are an Eligible Employee, the Plan will pay first and Medicare will pay second. If you are a Retired Participant or your family’s coverage under the Plan is not based on your current employment (as in the case of certain “COBRA” benefits), then once your Dependent becomes entitled to Medicare, Medicare will pay first and the Plan will pay second.
Coverage Under The Plan and Medicare When You Have End-Stage Renal Disease
If you or your Dependent are eligible for Medicare benefits based on disability status, and if you are a Retired Participant or your family’s coverage is not based on your current employment status, Medicare benefits will be paid first and Plan benefits second as discussed above. If you or your Dependent then develop end-stage renal disease and become eligible for Medicare benefits on that additional basis, Medicare will continue to pay benefits first and the Plan will continue to pay second. Otherwise, if you or your Dependent become entitled to Medicare because of end-stage renal disease (ESRD), this Plan pays first and Medicare pays second for 30 months starting the earlier of:
- the month in which Medicare ESRD coverage begins; or
- the first month in which the Participant receives a kidney transplant. Then, starting with the 31st month after the start of Medicare coverage, Medicare will pay first and the Plan will pay second.