Other Legal Information About Claims

Consistency of Treatment

The plan administrator will take such action from time to time as may be necessary to assure that all claims for benefits under the plan are determined in accordance with the applicable plan documents and that the provisions of the applicable plan documents are applied consistently to similarly situated plan participants and their dependents.

Coordination of Benefits

If you or your covered dependents have medical or dental coverage through another plan, your DallasNews Corporation plan will coordinate benefit payments with payments from the other plan. This means your benefit payments from all plans will not be more than the amount your DallasNews Corporation plan would have paid for eligible expenses if you had no other coverage.
The plan that pays first (as explained below) determines the amount of benefits you receive without considering other health care benefits you have under another plan. When the DallasNews Corporation plan pays benefits after another plan, DallasNews Corporation’s plan will reimburse you for the balance of allowable expenses not paid by the other plan, up to the amount that would have been paid if you had no other coverage.

How Coordination of Benefits Works

Let’s say your children are covered under both your spouse’s plan, which pays 70% of covered expenses, and DallasNews Corporation’s CDHP Medical Plan. You submit a $100 claim for your child’s outpatient lab services to your spouse’s plan. You would be reimbursed for $70 (70% of $100) from your spouse’s plan. You could then submit a claim for the remaining balance to Blue Cross and Blue Shield (BCBS). BCBS would pay $10 (assuming you already met your deductible, the lab services were provided in-network and the full expense was considered an allowable amount) so your total reimbursement from both plans is 80% of the cost of the service ($10 + $70 = $80) — the amount the CDHP would normally pay if you had no other coverage.
Your DallasNews Corporation plan coordinates benefits with the following other plans:
Group insurance plans
HMOs, group practices and other prepaid plans
Union welfare and employer plans
Government plans required by law, including Medicare and TRICARE
Plans for students enrolled at an educational institution.

Which Plan Pays First

A plan without a coordination of benefits provision is always the plan that pays first. If all the plans have a coordination of benefits provision, the plans pay according to the following rules:
1. The plan covering the person as an employee, rather than a dependent, pays first and the other pays second.
2. The plan covering a person as an active employee, (or that person’s dependent), pays before a plan covering a person who is laid off or retired (or that person’s dependent).
3. If a child is covered under both parents’ plans, the plan of the parent whose birthday (month and date regardless of year) falls earlier in the year pays first. However, if the other plan has a different provision for this situation, the provision of the other plan determines which plan pays first.
4. If a child is covered under both parents’ plans and the parents are separated or divorced with a court decree to establish financial responsibility for the child’s health care expenses, the plans pay benefits according to the court decree.
5. If a child is covered under both parents’ plans, the parents are divorced or separated, and there is no court decree to determine financial responsibility, their plans pay in this order:
First, the plan of the natural parent with physical custody,
Second, the plan of the spouse, if any, of the natural parent with physical custody, and
Last, the plan of the natural parent without physical custody.
If none of these rules apply, the plan that has covered the person the longest is the primary plan.

Medicare or TRICARE and Your Company Plan

If you work past age 65, you will be eligible for DallasNews Corporation medical coverage and Medicare. As long as you continue to work, the company’s medical plan is the primary plan. In calculating your benefits, Medicare benefits are coordinated (see Coordination of Benefits above) with those from this plan. Contact the Social Security Administration for more information about enrolling for Medicare. If you or a family member is or has been in uniformed military services you may be eligible for A.H. Belo medical coverage and TRICARE coverage. As long as you continue to work, the company’s medical plan is the primary plan. In calculating your benefits, TRICARE benefits are coordinated (see Coordination of Benefits above) with those from this plan. Contact the Defense Health Administration for more information about enrolling for TRICARE or go to www.tricare.mil which is the official website of the Defense Health Agency (DHA) a component of the Military Health System, DHA Address: 7700 Arlington Boulevard, Suite 5101, Falls Church, VA 22042-5101.

Liability for Payment

Neither DallasNews Corporation nor any DallasNews Corporation company will have any obligation to make a benefit payment to you or your dependents under a plan or program that is fully insured. The insurer is solely responsible to make such benefit payments, and DallasNews Corporation and the DallasNews Corporation companies will have no liability to you or your dependents if the insurer fails to make any payments required under any insured plan or program.
The plans and programs that are fully insured are the following:
Dental PPO and Dental HMO Plan
Vision Plan
EAP

Recovery of Overpayments

The amount of your plan benefits will be adjusted if:
You have misstated any information in your application for plan coverage (including any statement of health)
You do not report required information while receiving company-provided benefits
Any error is made in calculating your benefits
If a benefit is overpaid or benefits are duplicated, you are expected to repay the plan within 60 days. If you do not, the plan may reduce, refuse or offset future benefits until the overpayment is repaid. The plan may also take additional action allowed by law.
No interest will be charged on the amount of any overpayment or duplication of benefits and, unless required by law, no interest will be paid on any underpayment of benefits or on any benefit payments that have been delayed for any reason.