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Coordination of benefits Humana benefits are coordinated with similar benefits under other group hospital and medical service plans. In no event will use of the coordination of benefits provision cause the company to pay more than it would have paid, if no other coverage was involved. If we are the secondary carrier, our benefit will be the difference between the primary carrier's payment and 100 percent of eligible charges. Your contract will explain coordination of benefits in more detail. Deductible credit for takeover groups Any deductible amounts accumulated by an insured person under the employer's current group plan will be credited toward any deductible amount such insured person (employee and /or their eligible dependents) must pay for "major medical expenses" under Humana. Any reduction of the Humana deductible will be based on the amount of same or similar covered expenses incurred in the same calendar year under the prior plan. This credit will not apply if the group plan is replacing an HMO plan. Dependent coverage Eligible dependents include the employee's spouse and unmarried children from date of birth to the end of the calendar year in hich the child reaches the age of 25, provided the child is ependent upon the policyholder for support, lives in the household of the policyholder or is a full or part -time student. Pre - authorization requirement You (insured person) must receive pre - authorization to determine that each surgery, hospital admission and medical procedure /service meets our guidelines of reimbursable, medically necessary treatment. To obtain pre- authorization, you must present your identification card, which shows our toll -free pre - authorization telephone number, to the physician. Your physician must call for pre- authorization. If pre- authorization is not obtained, benefits may be reduced by 50 percent for the medically necessary services that were provided without authorization. You may be required to pay the entire cost of services you receive if authorization is denied, or if we later determine that the services weren't medically necessary or eligible for coverage. Skilled nursing facility Humana provides coverage in a skilled nursing facility each calendar year. Coverage for room and board is based on the facility's most common semi - private rate. Extension of coverage for totally disabled plan members Totally disabled employees or dependents may be covered for the disabling condition for a period of up to 12 months beyond the termination date of the plan. Home health care Humana covers home health care on a calendar year basis. Coverage is limited to our schedule of reasonable allowances. Maternity services If the plan your employer selected provides maternity benefits for employees and their eligible spouses, then those services will be provided on the same basis as any other illness. Check the exclusions in your certificate of insurance to determine if dependents are eligible for maternity coverage. Pre - admission testing Under Humana, pre- admission testing is fully covered at 100 percent. The deductible amount does not apply. Second surgical opinion Humana Health Care Plans provide full coverage for all second surgical opinions (including additional, not previously completed X -rays and laboratory tests). Second surgical opinions are not subject to a deductible. Spine and back disorders Coverage for spine and back disorders is limited to the benefits in the Certificate of Insurance. Waiting period for membership At the employer's option, new employees may be subject to a waiting period for membership in the plan. The provisions shown here are subject to change without notice. *Note: Check the exclusions in your Certificate of Insurance to determine if dependents are eligible for 9aternity coverage. FL- 66126 -HH (Formerly GHC FL -1285) 5/99 Florida