Medical Benefits
Your Stryker medical benefits are coordinated with benefits from:
  • Other employers' medical plans
  • Government plans
  • Motor vehicle plans when permitted by law
The Stryker medical plan is primary to medical coverage provided under a personal vehicle insurance policy, unless state insurance law requires otherwise.
Under the coordination of benefits provision, the amount normally payable by Stryker's plan is reduced to take into account payments from other plans. Your Stryker benefits, when combined with another plan's benefits, will not exceed what Stryker's plan would pay by itself. Refer to "Coordination of Benefits Examples" to see how coordination of benefits works under the medical plan.
However, the fact that you or your dependent may be covered by Medicaid or Medicare will not be taken into account in enrolling you or your dependent as a participant or in providing benefits to you or your participant under the Stryker plan.
Which Plan Pays First
If the other plan has no coordination of benefits provision, the other plan is considered primary and pays its normal benefits first. If both plans have a coordination of benefits provision, the plan covering the patient as an employee is primary and pays first. When Stryker's plan is primary, it pays benefits without considering what the secondary plan might pay. The secondary plan then pays its benefits, if any are due. When Stryker's plan is secondary, it pays only the difference between Stryker's normal benefits and the primary plan's payments. The Stryker medical plan is primary to medical coverage provided under a personal motor vehicle insurance policy, unless state insurance law requires otherwise.
Determining the Allowable Expense If This Plan Is Secondary
Allowable Expenses
For purposes of coordination of benefits (COB), an allowable expense is a healthcare expense that is covered at least in part by one of the health benefit plans covering you.
When the UnitedHealthcare plan is secondary, the allowable expense is the primary plan's in-network rate. If the primary plan bases its reimbursement on reasonable and customary charges, the allowable expense is the primary plan's reasonable and customary charge. If both the primary plan and this plan do not have a contracted rate, the allowable expense will be the greater of the two plans' reasonable and customary charges.
For Dependent Children
When both parents' plans cover an eligible child, the plan of the parent whose birthday comes first in the calendar year is primary. If both parents have the same birthday, the plan that has covered either parent for the longer period of time is primary. However, if the other plan does not have this birthday rule and, as a result, the plans do not agree on the order of benefits, the rule in the other plan will determine the order of benefits.
If the parents are divorced, the following guidelines apply:
  • If the parents have joint custody and there is no court decree stating which parent is responsible for healthcare expenses, the birthday rule stated above will apply.
  • If one parent has custody, his or her plan is primary and the other parent's plan is secondary unless the divorce decree states otherwise.
  • If the parent with custody remarries, the step parent's plan is secondary. If the remarried parent with custody has no healthcare coverage, the step parent's plan is primary and the plan of the natural parent without custody is secondary.
  • The plan that covers a parent as a retired or laid-off employee (or the dependent of a retired or laid-off employee) is secondary to a plan that covers a parent as an active employee (or the dependent of an active employee). However, if the other plan does not have the same rule, this provision will not apply.
If none of the above situations apply, the plan that has covered the patient for the longest period of time is primary.
Coordination with Medicare
This plan coordinates with Medicare based on the reason for Medicare eligibility, as described below.
Age 65
If you are still working for Stryker when you reach age 65:
  • You may continue your Stryker coverage as primary, with Medicare secondary.
  • You may choose to be covered only by Medicare.
If he or she is covered under the Stryker medical plan, your spouse also has these options at age 65 no matter how old you are at that time.
Medicare Crossover Program
The plan offers a Medicare Crossover program for Medicare Part A and Part B and durable medical equipment (DME) claims. Under this program, you no longer have to file a separate claim with the plan to receive secondary benefits for these expenses. Your dependent will also have this automated crossover, as long as he or she is eligible for Medicare and this plan is your only secondary medical coverage.
Once the Medicare Part A and Part B and DME carriers have reimbursed your health care provider, the Medicare carrier will electronically submit the necessary information to the Claims Administrator to process the balance of your claim under the provisions of this plan.
You can verify that the automated crossover took place when your copy of the explanation of Medicare benefits (EOMB) states your claim has been forwarded to your secondary carrier. This crossover process does not apply to expenses that Medicare does not cover. You must continue to file claims for these expenses.
For information about enrollment or if you have questions about the program, call the telephone number listed on the back of your ID card.
End-Stage Renal Disease
If you or a covered dependent are eligible for Medicare due to end-stage renal disease, Stryker's medical plan is primary during the first 30 months of dialysis treatment; after this initial period, Stryker's plan is secondary to Medicare.
Disability
A disabled individual becomes eligible for Medicare (regardless of age) if the disability is certified by the Social Security Administration and has lasted at least 24 months. If this applies to you or a covered dependent, and you are still actively employed, Stryker's plan is primary and Medicare is secondary.
Medicare will become primary when any one of the following events occurs:
  • The disabled individual declines coverage under Stryker's plan,
  • The disabled individual is no longer covered by Stryker's plan, or
  • The disabled individual has exhausted benefits under Stryker's plan.
COBRA Coverage
Medicare is primary to the Stryker's medical plan if you or a family member is enrolled for COBRA continuation coverage and:
  • You or your spouse/domestic partner is enrolled for Medicare based on age, or
  • You or a family member is enrolled for Medicare due to disability.
Effect of Prior Coverage
If coverage for you or a dependent under this plan replaces any prior coverage, either partially or completely, any benefits provided under the prior coverage may reduce benefits payable under this plan. Prior coverage is any health plan sponsored by an employer.
Coordination of Benefits Examples
For example, your spouse is covered by Stryker's plan as well as his or her employer's medical plan. After any deductibles or copayments, covered medical expenses total $2,000.
CASE #1: The other plan is the primary payer and pays 75% of covered expenses. Stryker's plan is secondary and pays 80% of covered expenses. Here's how to determine how much Stryker's plan pays as the secondary payer:
Stryker's plan normally pays 80% of covered expenses:
80% × $2,000 = $1,600
Other plan actually pays 75% of covered expenses:
75% × $2,000 = $1,500
Balance to be paid by Stryker's plan:
$1,600 – $1,500 = $100
CASE #2: If the other plan is primary and pays 80% or more of covered expenses, Stryker's plan would not pay any benefits, as shown below:
Stryker's plan normally pays 80% of covered expenses:
80% × $2,000 = $1,600
Other plan actually pays 80% of covered expenses:
80% × $2,000 = $1,600
Balance to be paid by Stryker's plan:
$1,600 – $1,600 =$0