Reso 2001-399 - Laserfiche WebLink

Home Browse Search

ORDER OF BENEFIT DETERMINATION RULES, To decide which Plan pays fIrst, the Company will use the fIrst of the following rules which applies. (1) Noncoordinated/Coordinated Plan. A Plan without a coordination provision will pay its benefIts before a Plan which includes a coordination provision. (2) Nondependent/Dependent. A Plan covering the Claimant as an employee, member or subscriber will pay its benefIts before a Plan covering the Claimant as a dependent. (3) Child of Parents Not Separated or Divorced, If the Claimant is a dependent child whose parents are not separated or divorced, the Plan of the parent whose birthday falls earlier in the calendar year will pay fIrst. However: (a) if both parents have the same birthday, the Plan which has covered the parent longer will pay fIrst; and (b) if the Plan coordinates benefIts based upon the sex of the parents, the male parent's plan will pay fIrs t. (4) Child of Separated or Divorced Parents. If the Claimant is a dependent child whose parents are separated or divorced, then: (a) the Plan of the parent who is required by court decree to pay the child's dental expenses will pay fIrst; (b) provided the Plan receives notice of the court decree before paying or providing benefIts. If there is no notice of a court decree requiring payment of such expense, then: (a) the custodial parent's Plan pays fIrst; (b) the Plan of the custodial parent's spouse pays next (if the custodial parent is remarried); and (c) the noncustodial parent's Plan pays last. When a noncustodial parent is responsible for the Claimant's dental expenses, benefIts may be paid directly to the provider, if the custodial parent requests this. (5) Active/Inactive Employee, A Plan covering the Claimant as a laid off or retired employee (or a dependent of such an employee) will pay after a Plan covering the Claimant on some other basis; provided the other Plan: (a) includes this coordination rule for laid off or retired employees; or (b) is issued in a state which requires this rule by law, A Plan covering the Claimant pursuant to federal COBRA Continuation law will pay after a Plan covering the Claimant as an employee (or a dependent of an employee). (6) Leneth of Coveraee. If none of the above rules apply, then the Plan which has covered the Claimant longer will pay fIrst. RIGHT TO EXCHANGE DATA. To determine the benefIts payable under this section, the Company has the right to exchange information with any insurance company, organization or person. Such data may be exchanged without the consent of (or any notice to) the Covered Person, A Covered Person who claims benefIts under this Policy must provide the Company with the data required to apply this Section, PAYMENT AND OVERPAYMENT. Other Plans may make payments which this Plan should have made in accord with this Section, In that event, the Company has the right to reimburse any amount it deems necessary to satisfy the intent of this Section, If the Company pays such benefIts to an organization in good faith, it will not be liable to the extent of the payment. The Company also has the right to recover any overpayment it makes because of coverage under another Plan, The Company may recover the amounts needed to satisfy the intent of this Section from any insurance company, organization or person to or for whom Policy benefIts were paid. 24 Savings 09/01/01 GL11-17.1 COB