Common use of Effect of Medicare Clause in Contracts

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 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- of-Network option under Section IV.