Custodial Parent. The parent awarded custody by a court decree or, in the absence of a court decree, is the parent with whom the child resides more than one half of the calendar year excluding any temporary visitation. Order of Benefit Determination Rules When a person is covered by two or more Plans, the rules for determining the order of benefit payments are as follows: A. The Primary Plan pays or provides its benefits according to its terms of coverage and without regard to the benefits of under any other Plan. (1) Except as provided in Paragraph (2), a Plan that does not contain a coordination of benefits provision that is consistent with this regulation is always primary unless the provisions of both Plans state that the complying Plan is primary. (2) Coverage that is obtained by virtue of membership in a group that is designed to supplement a part of a basic package of benefits and provides that this supplementary coverage shall be excess to any other parts of the Plan provided by the contract holder. C. A Plan may consider the benefits paid or provided by another Plan in calculating payment of its benefits only when it is secondary to that other Plan. D. Each Plan determines its order of benefits using the first of the following rules that apply:
Appears in 15 contracts
Sources: Group Agreement, Group Agreement, Group Agreement