Lehigh’s medical plans will be the primary coverage for the employee’s spouse/partner only if one of the following is true:
The spouse/partner does not have access to another employer-sponsored medical benefit in which the employer pays at least 50 percent of the premium cost, or
The employee elects to pay an additional monthly cost of $100 to enroll a working spouse/partner who could otherwise have enrolled in an employer-sponsored medical benefit with his or her employer.
In all other cases, Lehigh’s carriers will process claims as if the employee’s spouse/partner has primary coverage with an employer and will coordinate benefits under the standard “non-duplication of benefits” provision. This means that Lehigh’s plan will assume another carrier has processed the claim first and at the level the Lehigh plan would have paid. Since Lehigh plans will not make additional payments on claims that have already been paid at the Lehigh plan level of benefits (i.e., non-duplication of benefits), no additional claim payment will be possible.