Dual Coverage (Coordination of Benefits) Some employees and dependents have health care coverage under another employer's plan in addition to the McClatchy plan. For instance, children might be covered under both the McClatchy plan and the spouse's medical plan. This is called dual coverage. When there is dual coverage, the health plans may coordinate benefit payments.

The coordination of benefits rules to determine which plan pays first may differ from plan to plan. You should check each plan's Summary of Coverage booklet for details on how that plan will coordinate benefit payments.

Preventive Care Many (but not all) plans pay 100 percent for preventive care coverage. Child immunizations, routine physicals, well women exams and mammograms, are all covered under preventive care. Preventive care services are usually paid at a co-pay or 100 percent co-insurance and generally are not subject to the deductibles. You should ask your doctor to be sure to code these services as preventive care on the claim form sent to the health plan.

Pre-certification/Pre-Authorization/Medical necessity Some procedures require pre-certification or pre-authorization in order to be covered. The health plans do this in order to ensure the procedures are medically necessary and appropriate for the diagnosis. Services typically covered under pre-certification requirements include in-patient surgeries, hospital stays, hospice care, and skilled nursing facilities. You can check your Summary of Coverage booklet, the health plan customer service line, or human resources to determine which benefits require pre-certification, and whether you or your provider is responsible for obtaining the pre-certification form from the health plan. Some plans will charge a penalty if you do not obtain the required pre-certification.