When we say that United “administers” a Benefit Plan, we mean that United processes your claims for reimbursement under a Benefit Plan sponsored and funded by your or your spouse’s employer. By “out-of-network” provider, we refer to a health care provider who has not entered into a participating provider agreement with United. In this article, United will discuss the COB procedure that it employs most frequently when you receive health services from an out-of-network provider or a provider who does not accept Medicare, and United must perform COB between Medicare and a Benefit Plan that it insures or administers. If you require information regarding your Employer Plan or to learn exactly how a particular claim was processed, you should consult your Employer Plan documents or contact United’s customer service department at the phone number listed on the back side of your insurance card. For example, some states mandate COB practices that may differ from the practices reflected in this article, and United will follow the laws or regulations that apply in those states. ![]() The terms of the Employer Plan and applicable law will always govern in determining any entitlement to benefits. The Benefit Plan to which you are a member may vary from the practices contained in this article. (“United”)* will determine the amount of benefits to which you are entitled under the Benefit Plan administered by United using a procedure called “Coordination of Benefits” or “COB.” This article does not provide an exhaustive explanation of how COB applies to all Benefit Plans. ![]() When you or your dependents have coverage under more than one health care benefit plan, policy or arrangement (“Benefit Plan”), an affiliate of UnitedHealthcare Services, Inc.
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