Reductions/Exclusions for Duplicate Coverage
If you are entitled to benefits from any of the following sources, plan benefits will be reduced by either the amount of actual benefits paid or the reasonable value of services provided by these sources:
  • Benefits provided under Title 18 of the Social Security Act ("Medicare"). Plan benefits will be paid less the amount paid under Medicare.
  • Benefits provided by any other federal, state or governmental agency, or by any county or other political subdivision, except for benefits from MediCal.
  • Benefits to which you are entitled under Workers' Compensation or other similar laws.
  • Benefits provided under any other health care service plan or HMO.
  • Benefits provided under the extension of benefits provision of any group, blanket or franchise disability insurance policy, any other health care service plan, any hospital service plan, or any self-insured welfare benefit plan.