62 Coordination of Benefits The benefits provided by this Plan are coordinated with any benefits payable to you, your Spouse, or your Eligible Dependent Child for the same expenses paid from other group health plans or insurance plans. Coordination means that benefits from the Plan described in this SPD and from other benefit plans and insur ance plans cannot exceed 100% of the allowable expense for each cove red individual in each calendar year. Coordination is intended to permit up to the full payment of actual allowable expenses without duplication of benefits. Please Note : There is no Co ordination of Benefits under the Prescription Drug Coverage . P rescription drug copayments and coinsurance are not reimbursable u nder the medical Plan benefits. There are several circumstances that may result if you, your Spouse, and/or your Eligible Depend ent Child are reimbursed for your medical expenses from this Plan and from another source. If any of the possible sources of payment for health benefits, as listed below, apply in the case of you, your Spouse, or Eligible Dependent Child, you must let this Plan know about all such plans under which you have cover age. The application of the COB provisions can occur if you, your Spouse, and/or an Eligible Dependent Child also is covered by: • Medicare or some other government program; • Another group health care plan; • Motor vehicle no - fault coverage for medical expenses; • Workers’ Compensation; or • If a spouse is employed and covered by a high deductible health plan with a Health Savings Account (HSA), that spouse cannot be covered by ano ther group health plan. Effect of Coordination Benefits When a covered individual is entitled to medical benefits or services under more than one plan, the rules shown in the order as set fo rth below will be used to decide which plan is the Primary plan . If the Plan described herein: 1. Is the Primary Plan among all plans that cover the participant, then its benefits will be determined without taking into account the benefits or services of any other plan. 2. Is not the Primary Plan , then its benefits may be reduced. The benefits will be reduced so that the benefits provided by all plans will not be more than 100% of the allowable expenses incurred by the applicable participant. The benefits provided under a Plan include the benefits that would have been provi ded if a claim had been duly made. The benefits from this Plan will never be greater than those that would be paid in the absence of other coverage. How Much the Plan Pays When it is Secondary W hen the Plan described in this SPD pays second, it will pay th e same benefits that it would have paid had it paid first, less whatever pay ments were made by the plan (or plans) that was required to pay first. In addition, when this Plan pays second, it will never pay more in benefits than it would have paid had it pa id the claim as the primary plan. Copayments , coinsurance, and exclusions of this Plan still apply. As a result, when this Plan pays second, you may not receive 100% of the total cost of the covered health care services.
2018 BTF Plan C Page 66 Page 68