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2020/12/16 Council Agenda Packet
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2020/12/16 Council Agenda Packet
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Council Agenda Packet
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12/16/2020
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(iv) If a court decree states that the parents have joint custody without <br />specifying that one parent has responsibility for the health care expenses <br />or health care coverage of the dependent Child, the provisions of <br />subsection (a) above determine the order of benefits; or <br />(v) If there is no court decree allocating responsibility for the dependent <br />Child's health care expenses or health care coverage, the order of benefits <br />for the Child are as follows: <br />• The Plan covering the Custodial Parent, first; <br />• The Plan covering the spouse or domestic partner of the Custodial <br />Parent, second; <br />• The Plan covering the noncustodial parent third, and then <br />• The Plan covering the spouse or domestic partner of the noncustodial <br />parent, last. <br />(c) For a dependent Child covered under more than one Plan of individuals who <br />are not the parents of the Child, the provisions of subsection (a) or (b) above <br />determine the order of benefits as if those individuals were the parents of the <br />Child <br />3. Active employee or retired or laid -off employee. The Plan that covers a person as <br />an active employee, that is, an employee who is neither laid off nor retired is the <br />P rimary Plan The Plan covering that same person as a retired or laid -off employee <br />is the Secondary Plan The same would hold true if a person is a dependent of an <br />active employee and that same person is a dependent of a retired or laid -off <br />employee. If the other Plan does not have this rule, and as a result, the Plans do <br />n ot agree on the order of benefits, this rule is ignored. This rule does not apply if <br />the rule under section e.1. can determine the order of benefits. <br />4. COBRA or state continuation coverage. If a person whose coverage is provided <br />u nder COBRA or under a right of continuation provided by state or other federal <br />law is covered under another Plan, the Plan covering the person as an employee <br />member, subscriber or retiree or covering the person as a dependent of an <br />employee, member, subscriber or retiree is the Primary Plan and the COBRA or <br />state or other federal continuation coverage is the Secondary Plan. If the other <br />P lan does not have this rule, and as a result, the Plans do not agree on the order <br />of benefits, this rule is ignored. This rule does not apply if the rule under section <br />e .1. can determine the order of benefits <br />5. Longer or shorter length of coverage. The Plan that covered the person as an <br />employee member, policyholder, subscriber or retiree longer is the Primary Plan <br />and the Plan that covered the person the shorter period of time is the Secondary <br />Plan <br />6. If the preceding rules do not determine the order of benefits the Allowable <br />Expenses must be shared equally between the Plans meeting the definition of <br />P lan. In addition, This Plan will not pay more than it would have paid had it been <br />the Primary Plan. <br />001 L-WA81 1 (5/20) 11 <br />
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