Special regulations determine how a private medical plan, like GuideStone’s Personal Plans, pays benefits in coordination with Medicare. These regulations are called Medicare Secondary Payer (MSP) rules and are based on employer size. In general:

• If an employer has fewer than 20 employees over a certain time period, then the employer is considered exempt from MSP rules and Medicare pays benefits before GuideStone’s Personal Plans. In this case, Medicare is the ''primary'' payer of claims.
• When Medicare is primary, employees on Medicare may enroll in one of GuideStone’s Care Plans. The Care Plus Plan and the Care Basic Plan both coordinate with Medicare coverage and also provide Part D prescription drug benefits.
• If an employer has 20 or more employees over a certain time period, then the employer is not exempt and Medicare pays after GuideStone Personal Plans. In this case, Medicare is the ''secondary'' payer of claims.
• When Medicare is secondary, employees on Medicare stay on GuideStone PPO Medical plans as long as they are actively working at this employer. Because GuideStone PPO benefits are paid before Medicare, the PPO health plans cost more than the Care Plans.