Non-Duplication of Benefits is a process that is used to determine the benefits paid by
the UEBT/UCBT Plan when a covered Participant, Spouse/Domestic Partner or Dependent Child is
covered under the UEBT/UCBT Plan and another health plan, and that other health plan is the
primary plan (meaning the other plan pays before the UEBT/UCBT Plan does). When the other
plan is the primary plan, the UEBT/UCBT Plan will pay benefits only if the primary plan’s
payment was less than the amount the UEBT/UCBT Plan would have paid if the UEBT/UCBT Plan were the
only plan providing benefits.
For example, if the other plan paid 80% of the allowed amount as the primary plan for
a specific service, and the UEBT/UCBT Plan would have paid 75% of the UEBT/UCBT Plan’s allowed
amount for that specific service if it was the only plan paying benefits, then the UEBT/UCBT
Plan will pay nothing, and the patient will be responsible for the remaining 20%. Another
example, if the primary plan paid 70% of the allowed amount for a specific service and
the UEBT/UCBT Plan would have paid 75% of the UEBT/UCBT Plan’s allowed amount for that specific
service if it was the only plan paying benefits, then the UEBT/UCBT Plan would pay 5%, and the
patient will be responsible for the remaining 25%.
Dual Coverage is a process that allows for full or 100% coordination of benefits. The
UEBT/UCBT Plan applies Dual Coverage in certain circumstances, which results in the UEBT/UCBT Plan
paying a greater amount than it would have paid under the Non-Duplication of Benefits process.
In order to be eligible for Dual Coverage, participants must meet all of the Fund’s eligibility
You and your Spouse/Domestic Partner must both work (or previously worked) for a
contributing employer currently making contributions into UEBT/UCBT.
- You and your Spouse/Domestic Partner must both be enrolled in the same medical carrier
(i.e. both must elect Blue Shield of California PPO or both must elect Kaiser).
You and your Spouse/Domestic Partner must both cover one another and the same Dependent
Children under each of your own Plans, provided your plan level allows you to enroll each
other and the same Dependent Children.
In addition, if either you or your Spouse/Domestic Partner is a UEBT/UCBT Active Member under
Premier or Ultra, you both must complete the Action Steps to be eligible for UEBT/UCBT’s wellness
program (HCP) – 100% dual coverage does NOT apply when one of you are not eligible for the
wellness program (this is sometimes referred to as being in the Personal Direction (PD) option.
When all of the Dual Coverage requirements have been met, the UEBT/UCBT will provide 100% or full coordination of benefits.