Other Insurance

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  1. 1. we are primary on everyone, even the stepchildren. Check once a year on spouse or domestic partner, (natural) children, and stepchildren.
  2. 3. is an individual plan that we do not coordinate with. We are prime on everyone. (There must be another record for other insurance – No or Yes.) This is for the CSA‘s information only. Must have two lines of other insurance values listed. One line for individual insurance and one line for any other insurance.
  3. 4. Lady Gaga is the employee of the music industry and has family coverage through UMR. Her date of birth is 6/4/1967. She is married to Billy Bob and his date of birth is 7/4/1966. They have 4 children together. Billy Bob is a stay at home dad and does not work outside the home. What other insurance value would you use.
  4. 6. there is family coverage under other UMR plan, but because of the birthday rule we are prime for children. Follow the internal COB procedures for the spouse or domestic partner. Pay the charges as prime for employee and children. Check once a year on spouse or domestic partner.
  5. 8. send delay EOB for other insurance information on spouse. We are prime for the employee and children. Our covered person’s birthday comes first in the year. No need for yearly check on natural children
  6. 9. Britney Spears is an employee of the pink company and has family coverage through UMR. Her DOB is 7/7/1970. Her 12 year old son is covered under his natural father per court order. What other insurance value would you use.
  7. 10. there must be a separate record for the spouse and natural children. Follow the internal COB procedures for the stepchildren.
  8. 11. UMR is secondary on hospital claims for spouse or domestic partner. Please check HealthPlan Database (HPDB) before processing physician charges.
  9. 12. send delay EOB for employee. UMR is secondary on the employee. Employee is either not an active employee or has ESRD.
  10. 13. UMR is primary on the employee. Employee is actively at work and over the age of 65 or has ESRD.
  11. 14. UMR is primary on the employee and spouse or domestic partner.
  12. 15. COB form to UMR Other Insurance for employee (W-OI). We are prime for employee. Check once a year on employee.
  13. 16. we are prime for everyone. Check once a year on spouse or domestic partner and children. (CSA calls employer for information and must update CC# on 110 screen.) Spouse does not have insurance at this time.
  14. 17. UMR is secondary on hospital claims for employee. UMR could be primary or secondary on physician claims. Please check HealthPlan Database (HPDB) before processing physician charges. (There must be another records for spouse or domestic partner.)
  15. 18. send delay EOB for employee, spouse or domestic partner. UMR is secondary on the employee and spouse or domestic partner. Employee is either not an active employee, or employee, spouse or domestic partner has ESRD.
  16. 19. no coverage for children under other UMR plan – single coverage only. Follow the internal COB procedures for the spouse or domestic partner. We are prime for the employee and children. Check once a year on the children.
Down
  1. 2. we are prime for everyone. Check once a year on spouse and children. (CSA calls employer for information and must update CC# on 110 screen.) Our covered person’s birthday comes first in the year. Spouse does not have other insurance at this time
  2. 3. send delay EOB for other insurance information on spouse/domestic partner. We are prime for the employee and children. Check once a year on the children. Spouse has single coverage, but could add dependent coverage. Our covered person’s birthday does not come first in the year.
  3. 5. send deny EOB for other insurance information on spouse and children. Our covered person’s birthday does not come first in the year. Spouse has family coverage.
  4. 6. follow the internal COB procedures for spouse/domestic partner and children. We are prime for the employee.
  5. 7. we are prime for everyone, even the stepchildren. We are prime per the birthday rule for the natural children. Check once a year on the spouse or domestic partner and stepchildren. No need for yearly check on natural children.
  6. 9. send delay EOB for other insurance information on stepchildren. There must be another record for the spouse or domestic partner and natural children. Must have two lines of Other Insurance Values listed.
  7. 10. we are prime for the employee. Charges for the children will be processed by the batch as prime and a COB form will be created for the secondary UMR carrier. There must be another record for the spouse or domestic partner, if spouse/domestic partner has other insurance. Follow the internal COB procedures for children – situation might be divorce.
  8. 11. UMR is secondary on physician charges for employee. UMR could be primary or secondary on hospital claims. Please check HealthPlan Database (HPDB) before processing physician charges. (There must be another records for spouse or domestic partner.)
  9. 12. send delay EOB for spouse or domestic partner. UMR is secondary on the spouse or domestic partner. Employee is either not an active employee or spouse had ESRD.
  10. 13. UMR is primary on spouse or domestic partner. Employee is actively at work and over the age of 65 or spouse or domestic partner has ESRD.
  11. 14. please check HealthPlan Database (HPDB) before processing hospital or physician charges. UMR could be primary or secondary.
  12. 15. Follow the internal COB procedures.
  13. 16. send delay EOB for the employee. Check once a year on employee. There must be another record for the dependent.
  14. 17. UMR is secondary on physician charges for spouse or domestic partner. UMR could be primary or secondary on hospital claims. Please check HealthPlan Database (HPDB) before processing physician charges.
  15. 18. please check HealthPlan Database (HPDB) before processing hospital or physician charges. UMR could be primary or secondary
  16. 19. follow the internal COB procedures for the children. We are prime for employee and spouse or domestic partner (if there is one). Check once a year on the spouse or domestic partner (if there is one).