Common use of Medicare Coordinated Coverage Clause in Contracts

Medicare Coordinated Coverage. Individual rate must be justified by experience and may not exceed the calculated rate in the utilization data submission without written justification. It may not exceed 50% of the single rate for regular coverage, unless the BOARD’s consulting actuary determines that percentage to be lower. Medicare family 2 eligible rate shall be 2 times the individual Medicare coordinated rate; Medicare family 1 rate (1 under Medicare, 1 or more not eligible), shall be the sum of the individual rate (regular coverage) and individual rate (Medicare eligible). a) Individual b) Family 2 (all insureds under Medicare) c) Family 1 (at least 1 under Medicare, at least 1 other not under Medicare)