Effect of Medicare. Medicare primary/secondary payer guidelines and regulations will determine primary/secondary payer status, and will be adjudicated by KFHPWA as set forth in this section. KFHPWA will pay primary to Medicare when required by federal law. When Medicare, Part A and Part B or Part C are primary, Medicare's allowable amount is the highest allowable expense. When a Network Provider renders care to a Member who is eligible for Medicare benefits, and Medicare is deemed to be the primary xxxx xxxxx under Medicare secondary payer guidelines and regulations, KFHPWA will seek Medicare reimbursement for all Medicare covered services.
Effect of Medicare. Upon attaining eligibility to participate in Medicare Part B benefits, the formula used to calculate the District’s contribution to an eligible retiree’s HRA will be adjusted to be based on the premium for participation in a Medicare supplement plan, minus any minimum contribution paid directly to CalPERS. For employees who retired on or prior to June 30, 2021, the Medicare supplement plan rate used for this calculation will be no greater than the PERS Choice Medicare supplement plan rate that was in effect on the date of the employee’s retirement from District service. For employees who retire on or after July 1, 2021, the Medicare supplement plan rate used for this calculation will be no greater than the PERS Choice Medicare supplement plan rate in effect on the date on which the retired employee becomes eligible for Medicare.
Effect of Medicare. The following provisions explain how the benefits under this Certificate interact with benefits available under Medicare. A Member is eligible for Medicare if Member:
Effect of Medicare. Medicare primary/secondary payer guidelines and regulations will determine primary/secondary payer status, and will be adjudicated by KFHPWAO as set forth in this section. KFHPWAO will pay primary to Medicare when required by federal law. When Medicare, Part A and Part B or Part C are primary, Medicare's allowable amount is the highest allowable expense. When a Preferred Provider renders care to a Member who is eligible for Medicare benefits, and Medicare is deemed to be the primary xxxx xxxxx under Medicare secondary payer guidelines and regulations, KFHPWAO will seek Medicare reimbursement for all Medicare covered services. When a Member, who is a Medicare beneficiary and for whom Medicare has been determined to be the primary xxxx xxxxx under Medicare secondary payer guidelines and regulations, seeks care from Out-of-Network Providers, KFHPWAO has no obligation to provide any benefits except as specifically outlined in the Out-of-Network option under Section IV.
Effect of Medicare. Medicare primary/secondary payer guidelines and regulations will determine primary/secondary payer status, and will be adjudicated by Group Health as set forth in this section. Group Health will pay primary to Medicare when required by federal law. When Medicare, Part A and Part B or Part C are primary, Medicare's allowable amount is the highest allowable expense. When a Network Provider renders care to a Member who is eligible for Medicare benefits, and Medicare is deemed to be the primary xxxx xxxxx under Medicare secondary payer guidelines and regulations, Group Health will seek Medicare reimbursement for all Medicare covered services.
Effect of Medicare. Members Residing Outside the GHC Medicare Advantage Service Area. Medicare primary/secondary payer guidelines and regulations will determine primary/secondary payer status. When Medicare, Part A and Part B or Part C are primary, Medicare's allowable amount is the highest allowable expense.
Effect of Medicare. Medicare primary/secondary payer guidelines and regulations will determine primary/secondary payer status, and will be adjudicated by GHO as set forth in this section. When Medicare, Part A and Part B or Part C are primary, Medicare's allowable amount is the highest allowable expense.
a. When the MHCN renders care to a Member who is eligible for Medicare benefits, and Medicare is deemed to be the primary xxxx xxxxx under Medicare secondary payer guidelines and regulations, GHO will seek Medicare reimbursement for all Medicare covered services.
b. When a Member, who is a Medicare beneficiary and for whom Medicare has been determined to be the primary xxxx xxxxx under Medicare secondary payer guidelines and regulations, seeks care on a Self- Referred basis from Community Providers, GHO has no obligation to provide any benefits except as specifically outlined in the Community Provider option under Section IV.
Effect of Medicare. Medicare primary/secondary payer guidelines and regulations will determine primary/secondary payer status, and will be adjudicated by GHC as set forth in this section. When Medicare, Part A and Part B or Part C are primary, Medicare's allowable amount is the highest allowable expense. When GHC renders care to a Member who is eligible for Medicare benefits, and Medicare is deemed to be the primary xxxx xxxxx under Medicare secondary payer guidelines and regulations, GHC will seek Medicare reimbursement for all Medicare covered services.
Effect of Medicare. Medicare primary/secondary payer guidelines and regulations will determine primary/secondary payer status, and will be adjudicated by Group Health as set forth in this section. Group Health will pay primary to Medicare when required by federal law. When Medicare, Part A and Part B or Part C are primary, Medicare's allowable amount is the highest allowable expense. When a Network Provider renders care to a Member who is eligible for Medicare benefits, and Medicare is deemed to be the primary xxxx xxxxx under Medicare secondary payer guidelines and regulations, Group Health will seek Medicare reimbursement for all Medicare covered services. When a Member, who is a Medicare beneficiary and for whom Medicare has been determined to be the primary xxxx xxxxx under Medicare secondary payer guidelines and regulations, seeks care from Community Providers, Group Health has no obligation to provide any benefits except as specifically outlined in the Community Provider option under Section IV.
Effect of Medicare. When you become eligible for Medicare, you must notify MVP in writing and, except as described below, Medicare then becomes your Primary Plan. We will not provide benefits for any service or care for which benefits are payable under Medicare. When you are eligible for Medicare, we will reduce our benefits by the amount Medicare would have paid for the services or care. This reduction is made even if: you fail to enroll in Medicare; you do not pay the premiums or other charges for Medicare; or you receive services at a hospital or from a provider that cannot bill Medicare.
