Dependent Child/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 with custody of the child; (b) then, the plan of the spouse of the parent with the custody of the child; and (c) finally, the plan of the parent not having custody of the child. 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 paragraph 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.
Appears in 14 contracts
Samples: Membership Contract, Membership Contract, Membership Contract
Dependent Child/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 with custody of the child;
(b) then, the plan of the spouse of the parent with the custody of the child; and
(c) finally, the plan of the parent not having custody of the child. However, if the specific terms of a court decree state that one of the parents is responsible for the health or dental 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 paragraph does not apply with respect to any Claim Determination Period or Plan Year calendar year during which any benefits are actually paid or provided before the entity has that actual knowledge.
Appears in 3 contracts
Samples: Dental Benefit Plan, Dental Benefit Plan, Dental Benefit Plan
Dependent Child/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 with custody of the child;
(b) then, the plan of the spouse of the parent with the custody of the child; and
(c) finally, the plan of the parent not having custody of the child. However, if the specific terms of a court decree state that one of the parents is responsible for the health medical 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 paragraph does not apply with respect to any Claim Determination Period or Plan Year calendar year during which any benefits are actually paid or provided before the entity has that actual knowledge.
Appears in 2 contracts
Samples: Medical Benefit Plan, Medical Benefit Plan
