Dependent Child/Parents Separated or Divorced. If two or more plans cover a person as a dependent child of divorced or separated parents, the plan responsible to cover benefits for the child will be determined in the following order: • first, the plan of the parent with custody of the child; • then, the plan of the spouse of the parent with custody of the child; and • finally, the plan of the parent not having custody of the child. If the terms of a court decree state that: • one of the parents is responsible for the healthcare expenses of the child, and the entity obligated to pay or provide the parent's benefits under that parent's plan has actual knowledge of those terms, the benefits of that plan are determined first and the benefits of the plan of the other parent are the secondary plan. • both parents share joint custody, without stating that one of the parents is responsible for the healthcare expenses of the child, the plans covering the child will follow the order of benefit determination rules outlined above.
Dependent Child/Parents Separated or Divorced. If two or more Plans cover a person as a dependent Child of divorced or separated parents, benefits for the Child are determined in this order:
(i) First, the Plan of the parent with custody of the Child;
(ii) Then, the Plan of the spouse of the parent with custody of the Child;
(iii) Then, the Plan of the parent not having custody of the Child; and
(iv) Then, the Plan of the spouse of the parent not having custody of the Child. If the other Plan does not have this subparagraph (C)(2)(c) and if, as a result, the Plans do not agree on the order of benefits, this subparagraph (C)(2)(c) shall be ignored. However, if the specific terms of a court decree state that one of the parents is responsible for the health care expense of the Child, and the entity obligated to pay or provide the benefits of the Plan of that parent has actual knowledge of those terms, the benefits of that Plan are determined first. The Plan of the other parent shall be the Secondary Plan. This subparagraph does not apply with respect to any Claim Determination Period or Plan year during which any benefits are actually paid or provided before the entity has that actual knowledge. If the specific terms of the court decree state that the parents shall share joint custody, without stating that one of the parents is responsible for the health care expenses of the Child, the Plans covering the Child shall be subject to the order of benefit determination contained in subparagraph (C)(2)(b) above.
Dependent Child/Parents Separated or Divorced. If two or more plans cover a person as a Dependent child of divorced or separated parents, benefits for the child are determined in this order:
a. First, the plan of the parent who is ordered by divorce decree to maintain Coverage. If neither or both parents are ordered, the plan of the Sub xxxxxxx whose birthday falls earlier in the calendar year;
b. Then, the plan of the spouse of the parent who is ordered by divorce decree to maintain Coverage. If neither or both parents are ordered, the plan of the Subscriber whose birthday falls second among Subscribers in the calendar year;
c. Then the plan of the parent who is not ordered by divorce decree to maintain coverage. If neither or both parents are ordered, the plan of the Sub xxxxxxx whose birthday falls third among Sub xxxxxxx in the calendar year;
d. Finally, the plan of the spouse of the parent who is not ordered by divorce decree to maintain Coverage. If neither or both parents are ordered, the plan of the Subscriber whose birthday falls last among Subscribers in the calendar year. After the Dependent turns 18, the plan of the parent with whom the Dependent resides shall be the primary payer. If the Dependent does not reside with either parent, all Subscriber’s birthdates will be considered. A copy of the divorce decree may be requested for file documentation. There are many circumstances that affect order of benefit determination. Please contact HSA HEALTH INSURANCE COMPANY Customer Service for further clarification. When HSA HEALTH INSURANCE COMPANY is the primary plan, its Eligible Benefits are paid before those of the other health benefit plan and without considering the other health plan’s benefits. When HSA HEALTH INSURANCE COMPANY is the secondary plan, its Eligible Benefits are determined after those of the other health benefit plan and may be reduced to prevent duplication of benefits. When secondary, HSA HEALTH INSURANCE COMPANY calculates the amount of Eligible Benefits it would normally pay in the absence of the primary plan coverage, including Deductible, Coinsurance, and the application of credits to any Master Policy maximums. HSA HEALTH INSURANCE COMPANY then determines the amount the Member is responsible to pay after the primary carrier has applied its allowed contracted amount. HSA HEALTH INSURANCE COMPANY will then pay the amount of the Member’s responsibility after the primary plan has paid, up to the maximum amount it would have paid as the primary carrier. In no event will HSA H...
