iv Type of Claim or Appeal..........................................................................................................................83 Timing .....................................................................................................................................................83 Section 7: Coordination of Benefits .......................................................84 Benefits When You Have Coverage under More than One Plan............................................................84 When Does Coordination of Benefits Apply?..........................................................................................84 What Are the Rules for Determining the Order of Benefit Payments?....................................................84 How Are Benefits Paid When This Plan is Secondary?..........................................................................86 How is the Allowable Expense Determined when this Plan is Secondary? ............................................86 What is Different When You Qualify for Medicare?.................................................................................87 Medicare Crossover Program .................................................................................................................87 Right to Receive and Release Needed Information?..............................................................................88 Does This Plan Have the Right of Recovery?.........................................................................................88 Section 8: General Legal Provisions ......................................................90 What Is Your Relationship with the Claims Administrator and Plan Sponsor? .......................................90 What Is the Claims Administrator's Relationship with Providers and Plan Sponsors? ...........................90 What Is Your Relationship with Providers and Plan Sponsors?..............................................................91 Notice......................................................................................................................................................91 Statements by the Plan Sponsor or Participants.....................................................................................91 Does the Claims Administrator Pay Incentives to Providers?.................................................................91 Are Incentives Available to You? ............................................................................................................92 Does the Claims Administrator Receive Rebates and Other Payments? ...............................................92 Who Interprets Benefits and Other Provisions under the Plan?..............................................................92 Who Provides Administrative Services? .................................................................................................92 What is the Future of the Plan?...............................................................................................................93 Amendments to the Plan.........................................................................................................................93 How Does the Claims Administrator Use Information and Records?......................................................93 Does the Plan Require Examination of Covered Persons? ....................................................................94 Is Workers' Compensation Affected?......................................................................................................94 How Are Benefits Paid When You Are Medicare Eligible? .....................................................................94 Subrogation and Reimbursement ...........................................................................................................95 When Does the Plan Receive Refunds of Overpayments? ....................................................................98 Is There a Limitation of Action?...............................................................................................................98 What Is the Entire Plan? .........................................................................................................................99 Section 9: Defined Terms ......................................................................100 Clinical Programs and Resources ........................................................112 Care Management Solutions.................................................................................................................112 Personal Health Support.......................................................................................................................112 Complex Medical Conditions, Programs and Services .........................................................................113 Cancer Resource Services (CRS) Program..........................................................................................113 Kidney Disease Programs.....................................................................................................................113 Transplant Resource Services (TRS) Program.....................................................................................113 Complex Medical Conditions Travel and Lodging Assistance Program for the Covered Health Services Described Below ...................................................................................................................................114 Decision Support...................................................................................................................................114 Disease Management ...........................................................................................................................115 Reminder Programs..............................................................................................................................116 Consumer Solutions and Self-Service Tools.........................................................................................116 www.myuhc.com...................................................................................................................................116 UnitedHealth Premium® Designation Program.....................................................................................117 Amendments, Riders and Notices (As Applicable)