Reso 2010-1529 - Laserfiche WebLink

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1 13.03.01 The benefits of a policy or plan that covers the person as an ernployee, member, or subscriber, other than as a dependent, are determined before those of the policy or plan which covers the person as a dependent. 13.03.02 Except as stated in Subsection 13.03.03, when 2 or more policies or plans cover the same child as a dependent of different parents: a) The benefits of the policy or plan of the parent whose birthday, excluding year of birth, falls earlier in a year are determined before the benefits of the policy or plan of the parent whose birthday, excluding year of birth, falls later in the year; but b) If both parents have the same birthday, the benefits of the policy or plan which covered the parent for a longer period oftirne are determined before those of the policy or plan which covered the parent for a shorter period of time. c) However, if a policy or plan subject to the rule based on the birthday of the parents as stated above coordinates with an out-of-state policy or plan which contains provisions under which the benefits of a policy or plan which covers a person as a dependent of a male are determined before those of a policy or plan which covers the person as a dependent of a female and if, as a result, the policies or plans do not agree on the order of benefits, the provisions of the other policy or plan shall determine the order of benefits. 13.03.03 If 2 or more policies or plans cover a dependent child of divorced or separated parents, benefits for the child are determined in this order: ) -J a) First, the policy or plan of the parent with custody of the child; b) Second, the policy or plan of the spouse of the parent with custody of the child; and c) Third, the policy or plan of the parent not having custody of the child. d) However, if the specific terms of a court order state that one of the parents is responsible for the health care expenses of the child and if the entity obliged to payor provide the benefits of the policy or plan of that parent has actual knowledge of those terms, the benefits of that policy or plan are determined first. This does not apply with respect to any claim determination period or plan or policy year during which any benefits are actually paid or provided before that entity has that actual knowledge. 13.03.04 The benefits of a policy or plan which covers a person as an employee who is neither laid off nor retired, or as that employee's dependent, are determined before those of a policy or plan which covers that person as a laid off or retired ernployee or as that employee's dependent. If the other policy or plan is not subject to this rule, and if, as a result, the policies or plans do not agree on the order of benefits, this Subsection shall not apply. 13.03.05 If none of the rules in Subsections 13.03.01, 13.03.02, 13.03.03, or 13.03.04 determine the order of benefits, the benefits of the policy or plan which covered an employee, rnember, or subscriber for a longer period of tirne are determined before those of the policy or plan which covered that person for the shorter period of time. 13.03.06 Coordination of benefits shall not be permitted against an indemnity-type policy, an excess insurance policy as defmed in Chapter 627.635, F/orida Statutes, a policy with coverage limited to specified illnesses or accidents, or a Medicare supplement policy. However, if the person is also a Medicare beneficiary, and if the rule established under the Social Security Act of 1965, as amended, makes Medicare secondary to the plan covering the person as a dependent of an active employee, the order of benefit determination is: ) 35 A V -0100-2009 MP.53 19 (10/09)