COORDINATION OF BENEFITS

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Which Plan Pays First?
The order of payment between the two plans is determined according to the following rules (in order):

• If a person is covered by two group health plans and one plan does not have a coordination of benefits provision, that plan is always primary.
• Any plan that covers a person as a participant is primary over one that covers that person as a dependent.
• If a dependent child is covered under both parents' plans, and the specific terms of a court decree state that one of the parents is responsible for the child's health care expenses or health care coverage, and the plan of that parent has actual knowledge of the terms of that court decree, that plan pays first. However, this provision does not apply during any plan year during which any benefits were actually paid or provided before the plan had actual knowledge of the specific terms of that court decree.

If a dependent child is covered under both parents' plans and there is no court decree allocating responsibility for the child's health care expenses or coverage, the plan of the parent whose birthday (month and day, but not year) is earlier in the year will pay benefits first. If the parents have the same birthday, the plan that covers a parent longer will pay first. If the parents of a dependent child are divorced or legally separated and neither parent is remarried, the plan of the parent with custody of the child pays benefits first. If the parent with custody remarries, the order of payment is as follows:

• the plan covering the parent with custody pays first;
• the plan of the spouse of the parent with custody pays second; and
• the plan of the parent not having custody of the child pays last.

If the other plan does not have this rule but instead has a rule based on the gender of the parent and if, as a result, the plans do not agree on the order of benefits, the rule in the other plan will govern. This Plan will provide coverage to a dependent child under any court agency order that it determines to be a Qualified Medical Support Order (QMCSO) under federal law.

• The plan that covers a person as an employee who is neither laid‑off nor retired (i.e. an active employee), or as that active empIoyee's dependent, pays first; and the plan that covers the same person as a laid‑off or retired employee, or as that laid‑off or retired empIoyee's dependent, pays second. If the other plan does not have this rule, and if, as a result, the plans do not agree on the order of benefits, this rule is ignored.
• The plan that covers a person as an employee, member, subscriber or retiree (or as that person's dependent) is primary to the plan that provides coverage under a right of continuation pursuant to federal or state law. If the other plan does not have this rule, and if, as a result, the plans do not agree on the order of benefits, this rule is ignored.
• If none of the previous rules determines the order of benefits, the plan that covered an employee for the longer period of time pays without a break in coverage pays first; and the plan that covered that person for the shorter period of time pays second. To determine how long a person was covered by a plan, two plans are treated as one continuous plan as long as the person was eligible for coverage under the second plan within 24 hours after the first plan ended. The start of a new plan does not include a change in the amount or scope of a plan's benefits, in the entity that pays, provides or administers the plan's benefits, or from one type of plan to another (such as from a single employer plan to a multiple employer plan). The length of time a person is covered under a plan is measured from the first date of continuous coverage under that plan. If that date is not readily available, the date the person first became an eligible employee will be used to determine the length of time that person was covered under the plan presently in force.
• If none of the preceding rules determines the primary plan, the allowable expenses shall be shared equally between the plans.

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