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Jefferson Pilot Life Ins.#1
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RFP No. 01-10-01 Employee Dental, Life, Insurance
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Jefferson Pilot Life Ins.#1
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Last modified
6/18/2012 10:02:26 PM
Creation date
12/28/2010 3:46:06 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Employee Insurance
Bid No. (xx-xx-xx)
01-10-01
Project Type (Bid, RFP, RFQ)
RFP
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ORDER OF BENEFIT DETERMINATION RULES. To decide which Plan pays first, the Company will use the first of the <br />following rules which applies. <br />• (1) Noncoordinated /Coordinated Plan. A Plan without a coordination provision will pay its benefits before a Plan <br />which includes a coordination provision. <br />(2) Nondependent/Dependent. A Plan covering the Claimant as an employee, member or subscriber will pay its <br />benefits before a Plan covering the Claimant as a dependent. <br />(3) Child of Parents Not Separated or Divorced. If the Claimant is a dependent child whose parents are not <br />separated or divorced, the Plan of the parent whose birthday falls earlier in the calendar year will pay first. <br />However: <br />(a) if both parents have the same birthday, the Plan which has covered the parent longer will pay first; <br />and <br />(b) if the Plan coordinates benefits based upon the sex of the parents, the male parent's plan will pay <br />first. <br />(4) Child of Separated or Divorced Parents. If the Claimant is a dependent child whose parents are separated or <br />divorced, then: <br />(a) the Plan of the parent who is required by court decree to pay the child's dental expenses will pay <br />first; <br />(b) provided the Plan receives notice of the court decree before paying or providing benefits. <br />If there is no notice of a court decree requiring payment of such expense, then: <br />(a) the custodial parent's Plan pays first; <br />(b) the Plan of the custodial parent's spouse pays next (if the custodial parent is remarried); and <br />(c) the noncustodial parent's Plan pays last. <br />• When a noncustodial parent is responsible for the Claimant's dental expenses, benefits may be paid <br />directly to the provider, if the custodial parent requests this. <br />(5) Active/Inactive Employee. A Plan covering the Claimant as a laid off or retired employee (or a dependent of <br />such an employee) will pay after a Plan covering the Claimant on some other basis; provided the other Plan: <br />(a) includes this coordination rule for laid off or retired employees; or <br />(b) is issued in a state which requires this rule by law. <br />A Plan covering the Claimant pursuant to federal COBRA Continuation law will pay after a Plan <br />covering the Claimant as an employee (or a dependent of an employee). <br />(6) Length of Coverage. If none of the above rules apply, then the Plan which has covered the Claimant longer will <br />pay first. <br />RIGHT TO EXCHANGE DATA. To determine the benefits payable under this section, the Company has the right to exchange <br />information with any insurance company, organization or person. Such data may be exchanged without the consent of (or any notice <br />to) the Covered Person. A Covered Person who claims benefits under this Policy must provide the Company with the data required to <br />apply this Section. <br />PAYMENT AND OVERPAYMENT. Other Plans may make payments which this Plan should have made in accord with this <br />Section. In that event, the Company has the right to reimburse any amount it deems necessary to satisfy the intent of this Section. If <br />the Company pays such benefits to an organization in good faith, it will not be liable to the extent of the payment. <br />The Company also has the right to recover any overpayment it makes because of coverage under another Plan. The Company may <br />recover the amounts needed to satisfy the intent of this Section from any insurance company, organization or person to or for whom <br />Policy benefits were paid. <br />• <br />G1,11 -17.1 COB Savings <br />24 09/01/01 <br />
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