83 How Much the Plan Pays When it is Secondary When the Plan described in this SPD pays second, it will pay the same benefits that it would have paid had it paid first, less whatever payments 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 paid the claim as the primary plan. Deductibles, 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. Plan. The term plan for Coordination of Benefits purposes means a plan that provides benefits or services for medical care by or through any: • Group health plan, including group insurance and a self-insured group health plan; • Group practice or prepayment coverage; • Group service plan; • Method of coverage for persons in a group other than as shown in items 1, 2, and 3; or • Coverage that is required or provided by law. The term plan shall also include no-fault motor vehicle insurance. Understanding Coordination of Benefits Primary Plan. If a plan is considered primary, that plan is responsible for paying first, in accordance with its benefits schedule, all claims for a covered person. Secondary Plan. If a plan is considered secondary, that plan is responsible for paying benefits, if any remain, after the primary plan has paid its share. Pre-Paid Plans. Pre-Paid plans (HMOs, EPOs, etc.) that require use of specific providers and pay benefits to only those providers will always be primary for dependents whose coverage by the Pre-Paid plan is because they are, or were, an employee. In such cases, this Plan will reimburse only copayments or expenses that remain on covered charges after the Pre-Paid plan has paid benefits. Allowable Expense. Allowable Expense means any necessary, reasonable, and customary item or expense, at least a part of which is a covered expense under any of the plans that cover the person for whom the claim is made. When the benefits from a plan are in the form of services, not payments, the service is considered to be both an Allowable Expense and a benefit paid. Claim Determination Period. Claim Determination Period means a calendar year. Coordination of Benefits with Medicare and Other Government Programs Medicare. Generally, anyone age 65 or older is entitled to Medicare coverage. Anyone under age 65 who is entitled to Social Security Disability Income Benefits is also entitled to Medicare coverage after a waiting period. Medicare has two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). Part A covers inpatient Hospital care and generally is available to all individuals over age 65 at no cost. Part B covers