Intent
This Plan coordinates its benefits with other similar plans under which an individual is covered so that the total benefits available will not exceed 100% of the allowable expenses. This provision applies to the Trust’s indemnity medical and mental health and chemical dependency benefits.

Who These Apply To
The following coordination of benefit provisions apply to all those not eligible for U.S. Medicare. These provisions also apply to situations where:

• A dependent spouse under this Retiree Plan is eligible for Medicare and has other group health coverage as a retiree; or
• A retiree under this Retiree Plan is eligible for Medicare and is covered as an eligible spouse of a person who is also a retiree under this Retiree Plan.

If Both Spouses are Covered Under WTWT Plans
When a person is covered under this Plan in more than one capacity either, (1) as an employee or retiree and as a dependent of another employee or retiree; or (2) as a dependent child of more than one employee or retiree, coverage of the person in each capacity will be considered as a separate plan for purposes of this provision, and this provision will apply separately to the coverage of the person in each capacity as though such coverage were the primary plan and coverage of the person in the other capacity were the secondary plan.

Definitions

“This Plan” means medical and mental health and chemical dependency benefits described in this booklet on behalf of Retirees and their covered dependents not eligible for U.S. Medicare, excluding the Prescription Drug Program.

“Allowable Expense” is any necessary, usual, customary and reasonable expense covered, at least in part, by one of the plans of the same type (medical, or mental health and substance abuse treatment).

“Plans” means the following types of medical benefits: (a) coverage under a governmental program (except Medicaid but including Medicare) other than for a motor vehicle insurance contract; or (b) group insurance or other coverage for a group of individuals, but not including (i) franchise insurance or (ii) student coverage obtained through an educational institution.

“Claim Determination Period” means the part of a calendar year during which you or a dependent would receive benefit payments under this Plan if this section were not in force.

Effect on Benefits
Benefits otherwise payable under this Plan for allowable expenses during a Claim Determination Period may be reduced if:

• Benefits are payable under any other plan for the same allowable expenses; and
• The rules listed below provide that benefits payable under the other plan are to be determined before the benefits payable under this Plan.

The reduction will be the amount needed to provide that the sum of payment under this Plan plus benefits payable under the other plan(s) does not exceed 100% of allowable expenses. Each benefit that would be payable in the absence of this section will be reduced propor tionately. The total amount paid will be charged against any applicable benefit limit of this Plan.

For this purpose, benefits payable under other plans will include the benefits that would have been paid had claim been made for them. Also, for any person covered by Medicare Part A, benefits payable will include benefits provided by Medicare Part B, whether or not the person is covered under Part B.

Order of Benefit Determination
The benefits payable by a plan that does not have a coordination of benefits provision similar to the provision described in this section will be determined before the benefits payable of a plan that does have such a provision. In all other instances, the order of determination will be:

1. Employee or Retiree/Dependent. The benefits of a plan which covers the person for whom benefits are claimed as an employee or retiree, member , or subscriber (that is, other than as a dependent) are determined before the benefits of a plan which covers the person as a dependent.
2. Dependent Child - Parents Not Divorced. When this Plan and another plan cover the same child as a dependent, the benefits of the plan of the parent whose birthday falls earlier in a calendar year are determined before those of the plan of the parent whose birthday falls later in that year. If both parents have the same birthday, the benefits of the plan which covered the parent longer are determined before those of the plan which covered the other parent for a shorter period of time.
3. Dependent Child - Divorced Parents. If two or more plans cover a dependent child of divorced or separated parents, benefits for the child are determined in this order:
   • First, the plan of the parent with custody of the child;
   • Then, the plan of the spouse of the parent with custody of the child; and
   • Finally, the plan of the parent not having custody of the child.

   However, if the specific terms of a legally enforceable court decree state that one of the parents is responsible for the health care expenses of the child, and the entity obligated to pay or provide the benefits of the plan of that parent has actual knowledge of those terms, the benefits of that plan are determined first. This paragraph does not apply with respect to any Claim Determination Period or plan year during which any benefits are actually paid or provided before the entity has that actual knowledge.

4. Active/Inactive Employee. The benefit of a plan which covers a person as an employee who is neither laid off nor retired, or as that employee’s dependent, are determined before the benefits of a plan which covers that person as a laid-off or retired employee or as that employee’s dependent. If the other plan does not have this rule, and if, as a result, the plans do not agree on the order of benefits, this rule will not apply.
5. Longer/Shorter Length of Coverage. If none of the above rules determine the order of benefits, the benefits of the plan which covered an employee or retiree, member or subscriber longer are determined before those of the plan which covered that person for the shorter time.