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61 11/2005
5. Dependent Child/Parents Separated or Divorced – If two or more programs
cover a person as a dependent child of divorced or separated parents, benefits
for the child are determined in this order:
• First, the program of the parent with custody of the child,
• Second, the program of the spouse of the parent with custody of the child;
and
• Finally, the program of the parent not having custody of the child. However,
if the specific terms of a court decree state that one of the parents is
responsible for the child’s health care expenses, and the company obligated
to pay or provide the benefits of the program of that parent has actual
knowledge of those terms, the benefits of that program are determined first.
This paragraph does not apply with respect to any Claim Determination
Period or program year during which benefits are actually paid or provided
before the company has that actual knowledge.
6. Joint Custody – If the specific terms of a court decree state that the parents
shall have joint custody, without stating that one of the parents is responsible
for the health care expenses of the child, the programs covering the child shall
follow the order of benefit determination rules outlined above for “Dependent
Child/Parents not Separated or Divorced.”
7. Active/Inactive Employee – The benefits of a program that 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 program that covers that person
as a laid-off or retired employee (or as that employee’s dependent). If the
other program does not have this rule, and if, as a result, the programs do not
agree on the order of benefits, this rule is ignored.
8. Longer/Shorter Length of Coverage – If none of the above rules determines the
order of benefits, the benefits of the program which covered an employee or
member for a longer time are determined before those of the program that
covered that person for the shorter time.