You may be entitled to receive benefits under our benefit plan and another group benefit plan, if your spouse or domestic partner also has benefit coverage. In this case, the two plans will coordinate their benefit payments so that the combined payments of both plans will not be more than your actual expenses. The primary coverage plan will pay its full benefits. Then the secondary coverage plan will pay any expenses that are not completely covered by the primary coverage plan’s benefits. No plan pays more than it would without the coordination of benefits provision.

Claim Procedures under the Coordination of Benefits Provision

(1) If you are a covered member of the Fund, and are eligible for benefits from another Group Plan:

(a) Submit your claim to the Fund Office.

(b) After you have received payment for such claim from the Fund, you may submit this claim to the other Group Plan under which you are eligible for benefits.

(c) You will receive any additional benefits, which may be due for this claim under the second plan, but the total amount you receive for each claim from this Fund and from any other Group Plan cannot exceed 100% of allowable expenses.

(2) If your spouse or domestic partner has a claim and is eligible for benefits under another Group Plan:

(a) He/she must submit the claim to his/her plan first. (

b) After this claim is paid by that plan, it may be submitted to this Fund accompanied by an explanation of benefits received from the other plan.

(c) Any additional benefits which may be due for this claim will be paid by this Fund, but the total amount paid for this claim from this Plan will not exceed 100% of allowable expenses as determined by the Fund.

3) If a claim is submitted for a child when one parent is a covered member of this Fund, and the other parent is a covered member of another plan:

(a) Submit this claim to the Plan of the parent whose birthday (month and day only) occurs first in a calendar year.

(b) After the claim has been paid by the first plan, it may be submitted to the second plan along with an explanation of benefits received from the first plan.

(c) The payment you receive for each claim from both plans cannot exceed 100% of allowable expenses.

(4) If the claim is submitted for a child whose parents are divorced when one parent is a covered member of this Fund and the other parent is a covered member of another plan:

(a) If the parent with custody has not remarried,

(i) submit the claim to the Plan which covers the parent with custody first.

(ii) after the claim has been paid by the first plan then it may be submitted to the second plan along with an explanation of benefits received from the first plan.

(b) If the parent with custody has remarried,

(i) submit the claim to the plan which covers the parent with custody first.

(ii) submit the claim to the plan which covers the stepparent second.

(iii) submit the claim to the plan which covers the parent without custody last.

(c) In the event there is a court order which establishes financial responsibility for the medical, dental or other health care expenses of the child, submit the claim to the Plan which covers the parent with the court-ordered responsibility first.

BENEFITS QUESTIONS? PLEASE CONTACT MARY AT (631) 732-6500.

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