84 doctor’s services, outpatient Hospital services and other medical supplies and is optional. You must pay a monthly premium for Medicare Part B. Although you are eligible for Medicare Part A once you reach age 65, if you are an active participant, Part A coverage under Medicare is not automatic unless you have applied for Social Security benefits. Since Part A coverage is not automatic, you and your Spouse can register with Social Security for Part A when you reach age 65. You do not have to apply for Social Security payments (that is, actually retire), but you must apply and establish your entitlement to such benefits in order to be covered by Medicare. If you, your Spouse, or your Eligible Dependent Child are covered by the Plan and by Medicare, and you remain actively employed, your employer-sponsored group health plan will continue to provide the same benefits and the Plan will pay first (Primary) and Medicare will pay second (Secondary). If you are not actively employed, Medicare will be the Primary plan for any individual that is eligible for Medicare. Where Medicare is the Primary Plan, its benefits will be taken into account in determining any benefits to be paid under this Plan. The benefits of Medicare Parts A and B will be taken into account whether or not the participant has enrolled. This means that the benefits of Medicare Parts A and B will be estimated and benefits under this Plan will be reduced to the extent that benefits would have been paid had you enrolled in Medicare. In addition, if Medicare is the primary plan, and you elect to use a provider who does not participate in Medicare, the benefits of Medicare Parts A and B will be estimated and the benefits under this Plan will be reduced to the extent that benefits would have been paid had your provider been a Medicare participating provider. The Plan’s benefit payment will coordinate with Medicare’s payment. For covered expenses, the Plan will figure its benefit based on the total expense and then subtract the Medicare benefit and consider the balance as payable under the provisions of this Plan. For these expenses, the Plan carves out Medicare’s payment. However, federal law limits the amount a provider (Hospital, physician, etc.) can charge above the Medicare payment. The Fund cannot pay the provider more than the amount that Medicare shows as the patient liability for Medicare covered services, and the provider cannot legally bill for more than that amount. When Medicare is primary, claims should be submitted to Medicare first. After Medicare pays the claim, submit a copy of the claim, along with the Medicare explanation of benefits, to CareFirst Administrators. If you remain actively employed and you or any of your eligible Dependents become entitled to Medicare solely because of end-stage renal disease (ESRD), this Plan pays first (Primary) and Medicare pays second (Secondary) for 30 months starting the earlier of: • The month in which Medicare ESRD coverage begins; or • The first month in which the individual receives a kidney transplant. Then, starting with the 31 st month, Medicare pays first (Primary) and this Plan pays second (Secondary). For the first 30 months, as stated above, any Covered Medical Charges incurred by such disabled individual should be submitted to this Plan for payment with any unpaid balance submitted to Medicare.