COORDINATION OF BENEFITS
In the event the covered person has coverage under another plan that provides health care benefits, there will be coordination of benefits regarding the health care reimbursement under this Plan.
This coordination will apply in the event a covered expense is incurred under this Plan which also is covered under another plan or plans. A determination will be made as to which plan is the “primary” plan. The rules for determining which plan is primary are as follows:
- If the other plan does not have a coordination of benefits provision with regard to the particular expense, that plan is primary regardless of the following rules for such determination.
- The plan that covers the patient as an active employee is primary and the plan that covers the patient as a dependent is secondary.
- If the other plan has a provision that it is always secondary, then this plan will be secondary in coordination with such plan.
- If none of the above rules establishes which plan is the primary plan, the plan that has covered the patient the longest, continuously, in the period of coverage in which the expense is incurred is the primary plan.
If this Plan is the primary plan, it will pay its benefits as if there were no other plan.
If this Plan is not the primary plan, it will pay its benefits as if there were no other plan, except that this Plan will pay no greater part of a charge covered by this Plan and other plan(s) than that which when added to the part(s) payable by the other plan(s) equals 100% of such allowed charges.
This Plan will coordinate up to the Plan allowed charge not the billed charge.
DEPENDENT CHILDREN OF PARENTS NOT SEPARATED OR DIVORCED
- Birthday Rule: The plan covering the parent whose birthday falls earlier in the year pays first. The plan covering the parent whose birthday falls later in the year pays second. If both parents have the same birthday, the plan covers the parent longer pays first. The plan that covered the other parent for a shorter time pays second. A person’s year of birth is not relevant in applying this rule.
- The Transition Rule: Provides that if one coordinating plan uses the Birthday rule and the other uses the Male/Female rule, both plans will follow the birthday rule.
DEPENDENT CHILDREN OF SEPARATED OR DIVORCED PARENTS
When parents are separated or divorced, neither the Male/Female nor the Birthday rule apply. instead:
- The plan of parent with custody pays first
- The plan of the spouse of the parent with custody (the step Parent) pays next
- The plan of the parent without custody pays last
- The plan will comply with a Qualified Medical Child Support order