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The UPREHS Health Care Payment Plan (HCPP)
UPREHS is contracted as a Health Care Prepayment Plan (HCPP) with the Centers for Medicare and
Medicaid Services (CMS), the Federal agency that administers Medicare. This contract authorizes
UPREHS to pay your Original Medicare Part B claims to participating providers for office visits and
office services, consultations, hospital visits, and surgical procedures. When UPREHS HCPP receives a
participating physician’s claim for your services, payments for Original Medicare Part B benefits and
your UPREHS Medicare Secondary Plan benefits are made in one check directly to the physician, which
eliminates billing Railroad Medicare and you.
The UPREHS Medicare Secondary Plan
Claims for Medicare secondary benefits under the UPREHS MSP must be filed with UPREHS within
one-year of the time the claim was first processed by any Medicare claims processor.
The UPREHS Medicare Secondary Plan (MSP) makes payment for covered benefits after Original
Medicare Part A or B or the UPREHS HCPP has paid the primary Medicare payment for allowed services.
UPREHS MSP pays the Medicare Part A and B annual deductible amounts and coinsurance for allowed
charges for covered benefits. You may be partly or totally financially responsible for charges that
Medicare did not pay from nonparticipating providers. The UPREHS MSP reduces payment to 40% of the
Medicare coinsurance and annual deductible amounts for covered benefits from UPREHS nonparticipating
providers. A UPREHS nonparticipating provider is a physician, hospital, or other health care provider who
has not signed a UPREHS participation agreement. UPREHS does not know if these providers participate
with Medicare or not. All Medicare members who elect coverage under the UPREHS MSP are also automatically enrolled in the UPREHS Medicare HCPP. Members must be entitled to Original Medicare Part A and enrolled in Part B to elect coverage under the UPREHS MSP and HCPP.
Last Updated: 03/15/2010
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UPREHS. Plan for Life.™ 
