Coordination of benefits applies when you or covered dependents have health care coverage under more than one plan. The following rules determine whether the benefits of this plan are paid before or after the benefits of another plan. The benefits of this plan will not be reduced when, under these rules, this plan pays benefits first. The benefits of this plan may be reduced when another plan pays benefits first.
When there is a basis for a claim under this plan and another plan, this plan is the secondary plan (which pays benefits after the other plan) unless:
This plan determines its order of benefits by the first of the following rules that applies:
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The benefits of the plan that cover a person as an employee are determined before the benefits of the plan that cover a person as a dependent.
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When this plan and another plan cover the same child as a dependent of both parents:
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The benefits of the plan of the parent whose birthday falls earlier in the calendar year are determined before those of the plan of the parent whose birthday falls later in the year
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If both parents have the same birthday, the benefits of the plan that has covered a parent for the longer time are determined before the benefits of the plan that has covered a parent for the shorter time
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If the other plan has a rule based on gender of the parents instead of birthdays, the other plan's rule will determine the order of benefits.
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If two or more plans cover a dependent child of divorced or separated parents, benefits for the child are determined in this order:
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First, the plan of the parent with custody of the child
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Second, the plan of the spouse of the parent with the custody of the child
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Third, the plan of the parent without custody of the child.
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However, if a court decree states that one of the parents is responsible for the health care expenses of the child, the benefits of that plan are determined first.
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The benefits of a plan that covers a person as an active employee or dependent of an active employee will be determined before the benefits of a plan that covers a person as an inactive employee, continuation coverage, self-pay or laid off employee or the dependent of such a person. This rule is ignored if the other plan does not have the same rule and if, as a result, the plans do not agree on the order of payment.
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If none of the previous rules determine the order of benefits, the plan that has covered the employee or dependent for a longer time determines benefits before the plan that has covered the person for a shorter time.
