McKesson 2005 Annual Report Download - page 204

on behalf of the Plan shall coordinate its payments with those of the other plan(s) in accordance this Section K.
b. Active Executives.
With respect to active Executives and Dependents covered under the Plan, the benefits for each claim for benefits that would
otherwise be payable during a calendar year under this Plan in the absence of this provision shall be reduced by the benefits payable for such
claim under the other plans listed in Section K.1.d. below, for the expenses covered in whole or in part under this Plan. The rules in this
paragraph apply whether or not a claim is made under one of the other plans listed in Section K.1.d. below. When another plan provides
benefits in the form of services, the reasonable cash value of each service rendered, as determined within the sole discretion of the Insurance
Company will be considered both an expense incurred and a benefit payable.
c. Allowable Expense.
“Allowable Expense” for purposes of this Section K. means any health expense, part or all of which is covered under any of the plans
covering the person for whom a claim is made. The difference between the cost of a private hospital room and the semiprivate rate is not
considered an Allowable Expense unless the patient’s stay in a private hospital room is medically necessary, either in terms of generally
accepted medical practice or as specifically defined in the Plan and the Insurance Contract.
d. Other Plans.
As used in this Section K., the term “other plans” means any other plan of health expense coverage under group insurance or any
other type of coverage for persons in a group. This includes plans that are insured and those that are not.
e. Determination of Primary Plan.
Except with respect to an involved plan which is the Medicare program, the primary plan shall be determined as follows:
i. A plan with no rules for coordination with other benefits will be deemed to pay its benefits before a plan which contains such rules.
ii. A plan which covers a person other than as a dependent will be deemed to pay its benefits before a plan which covers the person as
a dependent.
iii. Except in the case of a dependent child whose parents are divorced or separated, the plan which covers the person as a dependent
of a person whose birthday comes first in a calendar year will be primary to the plan which covers the person as a dependent of a person whose
birthday comes later in that calendar year. If both parents have the same birthday, the benefits of a plan which covered one parent longer are
determined before those of a plan which covered the other parent for a shorter period of time.
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