Medicare And Other Federal Or State Government Programs. The provisions of this section will apply to the maximum extent permitted by federal or state law. HMO will not reduce the benefits due any Member due to that Member's eligibility for Medicare where federal law requires that HMO determine its benefits for that Member without regard to the benefits available under Medicare. The coverage under this Certificate is not intended to duplicate any benefits for which Members are, or could be, eligible for under Medicare or any other federal or state government programs (such as Workers' Compensation). All sums payable under such programs for services provided pursuant to this Certificate shall be payable to and retained by HMO. Each Member shall complete and submit to HMO such consents, releases, assignments and other documents as may be requested by HMO in order to obtain or assure reimbursement under Medicare or any other government programs for which Members are eligible. A Member is eligible for Medicare any time the Member is covered under it. Members are considered to be eligible for Medicare or other government programs if they:
Medicare And Other Federal Or State Government Programs. If the member obtains Medicare, they will be disenrolled from the Healthy Michigan Plan. Until disenrollment thefollowing will apply:
Medicare And Other Federal Or State Government Programs. The provisions of this section will apply to the maximum extent permitted by federal or state law. HMO will not reduce the benefits due any Member due to that Member's eligibility for Medicare where federal law requires that HMO determines its benefits for that Member without regard to the benefits available under Medicare. The coverage under this Certificate is not intended to duplicate any benefits for which Members are, or could be, eligible for under Medicare or any other federal or state government programs (such as Workers' Compensation). All sums payable under such programs for services provided pursuant to this Certificate shall be payable to and retained by HMO. Each Member shall complete and submit to HMO such consents, releases, assignments and other documents as may be requested by HMO in order to obtain or assure reimbursement under Medicare or any other government programs for which Members are eligible. Active Employees and Their Dependents Who Are Eligible For Medicare. Certain rules apply to active employees and their Covered Dependents who are eligible for Medicare. When an active Subscriber, or the Covered Dependent of an active Subscriber, is eligible for Medicare and the Subscriber or Covered Dependent belongs to a group covered by this Certificate with 20 or more employees, the coverage under this Certificate will be primary. If the Member belongs to a covered group of less than 20 employees, Medicare benefits will be primary and benefits payable under this Certificate will be secondary provided the Contract Holder elects to continue coverage for the active Subscriber or the Covered Dependent. Covered Persons Who Are Disabled or Who Have End Stage Renal Disease (ESRD). Special rules apply to Members who are disabled or who have End Stage Renal Disease. This Certificate will make primary and secondary payer determination in accordance with the Omnibus Budget Reconciliation Act (OBRA), as amended. Provision for Coordination with Medicare. HMO reserves the right to cover full benefits or to reduce benefits for any medical expenses covered under this Certificate. The amount HMO will pay will be figured so that the amount, plus the benefits under Medicare, will equal no more than 100% Allowable Expenses. Charges for services used to satisfy a Member's Medicare Part B deductible will be applied under this Certificate in the order received by HMO. Two or more charges for services received at the same time will be applied starting with the la...
