Opinion ID: 2005355
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Heading Rank: 3

Heading: Applicability of Exclusion for Benefits Covered by Medicare.

Text: To support his claim that the Medicare exclusion does not apply to him, Harrington relies on a provision in a Benefits Certificate that sets forth the comprehensive major medical coverage provided by UNI. [5] In the section listing, services not covered, the certificate states: You are not covered for services or supplies when you are entitled to claim benefits from governmental programs (except Medicaid). (Emphasis added.) Harrington argues this statement shows UNI intended only to exclude benefits if the retiree had a present right to Medicare benefits. In other words, if the retired employee had not enrolled in Medicare Part B, Harrington reasons, he would not be entitled to claim benefits from that governmental program within the meaning of the certificate provision. In searching for the meaning of contractual terms, we often resort to the dictionary to ascertain a term's common meaning. See Iowa Comprehensive Petroleum Underground Storage Tank Fund Bd. v. Farmland Mut. Ins. Co., 568 N.W.2d 815, 818 (Iowa 1997) (stating court consults dictionary for ordinary meaning of term); Fed. Land Bank of Omaha v. Bollin, 408 N.W.2d 56, 60 (Iowa 1987) (stating we interpret the language of the contract in accordance with its plain and ordinary meaning). The dictionary defines the word entitle as [a] right or legal title to: to qualify (one) for something: furnish with proper grounds for seeking or claiming something. Webster's Third New International Dictionary 758 (unabr. ed.2002). This definition would permit two interpretations of the word entitle as used in the benefits certificate: (1) having a right to Medicare benefits, or (2) being qualified or having the proper grounds to seek or claim Medicare benefits. When the word entitled is considered in the context of the entire benefits certificate, we think the latter meaning was clearly intended. Under a provision entitled Medicare eligibility, the certificate provides: If you are age 65 or older and no longer an employee, your eligibility for Medicare may terminate your . . . coverage under this certificate. (Emphasis added.) The reader is then referred to the coordination with Medicare section of the benefits certificate, which states that under federal law, Medicare is the secondary payer and group health plans are the primary payer in a variety of situations, none of which would encompass Harrington's circumstances. These provisions are consistent with an interpretation of the plan as excluding coverage for services that could be covered by Medicare, thereby making Medicare the primary coverage and the UNI plan secondary. Accordingly, we think the district court correctly determined that, once a retired employee is eligible for Medicare Part B, the retiree is entitled to claim benefits from that program, within the meaning of the contract exclusion. At that point, the UNI plan provides supplementary coverage. Further support for this interpretation of the plan is found in the booklet given to employees in which the terms of the plan are summarized. That document excludes medical services to which [the insured is] entitled by any government law even if [the insured is] not enrolled in such a plan.  (Emphasis added.) This provision clearly indicates that the word entitled is used in the broad sense of being eligible for Medicare Part B benefits. The trial court correctly interpreted the Medicare exclusion as applying to Harrington because he was eligible for Medicare and therefore entitled to such benefits, even though he had not enrolled in Medicare Part B.