In situations in which Medicare pays primary and the Unity member / Quartz participant doesn’t have Part B, if a member / participant is eligible for Medicare Part B and does not elect Medicare Part B, then Unity or Quartz will process the claims as if the member / participant has elected Medicare Part B, in accordance with the employer group’s policy documents or Summary Plan Description.
Unity or Quartz will process the claim according to the Medicare Fee Schedule.
Self-insured groups may design their plan’s Coordination of Benefits differently. Contact your Quartz account representative for more information.
E: COB with Medicare
In all cases, Coordination of Benefits (COB) with Medicare will conform to federal and state statutes and regulations. If your clients are eligible for Medicare benefits, but not necessarily enrolled, their benefits under this plan will be coordinated to the extent benefits otherwise would have been paid under Medicare as allowed by federal and state statutes and regulations. Except as required by federal and state statutes and regulations, this plan will pay benefits on a secondary basis to Medicare.
A letter was sent to current Unity members communicating the change of the claims process as outlined in the Certificate of Coverage and that the member can sign up for Medicare Part B during the open enrollment period (01/1 – 03/31) with Medicare Part B becoming effective 07/01/17. As of 07/01/17, if the member did not elect Medicare Part B, claims will process as if they did.
View List of Spring 2017 Unity Update Articles
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Quartz Health Solutions, Inc., Unity Health Plans Insurance Corporation, Gundersen Health Plan, Inc., Gundersen Health Plan Minnesota, Physicians Plus Insurance Corporation, Gundersen Health System, UnityPoint Health and UW Health are separate legal entities. Plans are underwritten by Unity Health Plans Insurance Corporation unless otherwise noted.