Coordination of benefits

BP's medical options coordinate with other medical coverage in which you may participate
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If you have medical coverage in addition to the BP Medical Plan, coverage under the BP Medical Plan is subject to coordination of benefit (COB) rules.

COB rules prevent a duplication or double payment of a provider’s charges for services. Under COB rules, the combined medical coverages pay up to, but not more than, 100% of covered expenses. You may never receive more than the actual charges.

COB rules generally apply to group insurance plans, no-fault auto insurance and Medicare. Under COB, one plan is primary and the other plan is secondary. In some instances, you may also have a third plan, which is known as tertiary. When a claim is made, the primary plan pays its benefits without any consideration to the secondary or tertiary plans. The secondary and tertiary plans adjust their benefits so that the total benefits paid by all plans will not be more than the total covered expenses.

The following rules determine which plan is primary:

  • A plan that does not coordinate benefits is the primary plan and determines its benefits first.
  • If you have continuation coverage under the BP Medical Plan and other group health coverage, the BP Medical Plan will not be the primary plan.
  • If your spouse/domestic partner is enrolled in his/her employer-sponsored health plan as an active employee, a COBRA participant or a retiree, that plan is the primary plan for him/her.
  • If your children are covered by the BP Medical Plan and your spouse’s/domestic partner’s employer-sponsored health plan, a rule known as the “birthday rule” will be applied to determine the order of benefit payments. Under this rule, the plan of the parent whose month and day of birth is earlier in the calendar year (not necessarily the older parent) is the primary plan. If both parents have the same birthday, the plan that has had coverage in effect longer is the primary plan.
  • If you are separated or divorced and your children are covered by more than one group health plan:
    • The plan of the natural parent with custody is the primary plan.
    • The plan of the spouse/domestic partner of the natural parent with custody is the secondary plan.
    • The plan of the other natural parent is the tertiary plan.
If the natural parent without custody has legal financial responsibility for the child’s medical care, the plan of that parent becomes the primary plan.
  • If you have coverage under a motor vehicle policy including liability, Medpay, PIP, no fault, underinsured motorist or uninsured motorist, such coverage is primary and the BP Medical Plan is secondary.
  • If an employee or dependent of an active employee has Medicare coverage, the BP Medical Plan is the primary plan for the person(s) with Medicare coverage and Medicare is the secondary plan, except in the case of a person who is Medicare-eligible due to end-stage renal disease, where special rules applya.
  • If a person has Medicare coverage and coverage under the BP Medical Plan other than as an active employee or dependent of an active employee (e.g., a COBRA participant), Medicare is the primary plan and the BP Medical Plan is the secondary plan, as long as no tertiary plan is involved. When the BP Medical Plan is the secondary plan, the benefits paid by Medicare are subtracted from the benefits that would normally be paid by the BP Medical Plan. The reduction of Medicare benefits is called a Medicare offset and will be applied on the basis that the Medicare-eligible person is enrolled in Medicare Part A and Part B, even if the person is not actually enrolled in Part B or is not Medicare-eligible. If a person permanently lives in the United States but is traveling temporarily outside the country, the BP Medical Plan will consider full plan benefits without applying the Medicare offseta

With coordination of benefits, if the BP Medical Plan is the secondary (or tertiary) plan and another plan covering you or a covered dependent is the primary plan, it is possible that the BP Medical Plan will not pay any benefits if the primary plan’s benefits are in all cases equal to or better than the BP Medical Plan’s benefits.

a Employees who receive Long-Term Disability (LTD) benefits from the BP Long-Term Disability Plan are typically considered active employees during the first 24 months of LTD. After 24 months, a person is no longer eligible for coverage as an active employee in the BP Medical Plan, regardless of the person's status on BP's payroll system. If you are receiving LTD benefits from the BP Long-Term Disability Plan, and are in the initial 24-month period, this plan will be the primary plan and Medicare will be secondary as long as you are considered an active employee by BP. After the earlier to occur of the end of this 24-month period or the termination of your active employment, Medicare will be the primary plan and the BP Medical plan will be secondary.


If you are enrolled in an HMO

If you are enrolled in an HMO, contact the HMO to learn how that plan coordinates benefits.

 

Publication date: April 2018

 

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