Policies of group insurance: Order of benefits. A policy of group insurance determines its order of benefits using the first of the following which applies:
1. A policy that does not coordinate with other policies is always the primary policy.
2. The benefits of the policy which covers a person as an employee, member or subscriber, other than a dependent, is the primary policy. The policy which covers the person as a dependent is the secondary policy.
3. When more than one policy covers the same child as a dependent of different parents who are not divorced or separated, the primary policy is the policy of the parent whose birthday falls earlier in the year. The secondary policy is the policy of the parent whose birthday falls later in the year. If both parents have the same birthday, the benefits of the policy which covered the parent the longer is the primary policy. The policy which covered the parent the shorter time is the secondary policy.
4. If more than one policy covers a person as a dependent child of divorced or separated parents, benefits for the child are determined in the following order:
(a) First, the policy of the parent with custody of the child;
(b) Second, the policy of the spouse of the parent with custody; and
(c) Third, the policy of the parent without custody of the child,
Ê unless the specific terms of a court decree state that one parent is responsible for the health care expenses of the child, in which case, the policy of that parent is the primary policy. a parent responsible for the health care pursuant to a court decree shall notify the insurer of the terms of the decree.
5. The primary policy is the policy which covers a person as an employee who is neither laid off nor retired, or that employee’s dependent. The secondary policy is the policy which covers that person as a laid off or retired employee, or that employee’s dependent.
6. If none of the rules in subsections 1 to 5, inclusive, determines the order of benefits, the primary policy is the policy which covered an employee, member or subscriber longer. The secondary policy is the policy which covered that person the shorter time.
Ê When a policy is determined to be a secondary policy it acts to provide benefits in excess of those provided by the primary policy. The secondary policy may not reduce benefits based upon payments by the primary policy, except that this provision does not require duplication of benefits.
Last modified: February 27, 2006