Res 1988-077 - Laserfiche WebLink

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(3) in a Calendar Year. If either Plan does not have the provisions of this paragraph regarding dependents, which results either in each Plan determining its benefits before the other or in each Plan determining its ben~Fits after the other¡ the provisions of this paragraph shall not apply, and the rule set forth in the Plan which does not have the provisions of this paragraph shall determine the order of benefits; except that in the case of a person for whom claim is made as a dep""-ndeY'~t ch i ld: í ¿\ ) WhE'.Y'i the pat-ents at'e sep:\r'ated >::.t' div()r'ced and the parent with custody of the child has not remarried, the benefits af a Plan which cover5 the chil~ as a dependent of the parent with custody af the child will be determined before the benefits of a Plan which c()Vet'S the child as a dependerlt of the parent with'Jllt cl..lst'Jdy. ( b) when the parents are divorced and the parent with the custody of the chi ld has remar't'ied, the benefits of a Plan which cI::.vet'S that child as a dependent of the parent with custody shall be deter'mi Y'led befc,t'e the benefi ts IJf a Plan wh ich CIJvers that ch i ld as a dependent of the step-parent, and the benefits of a Plan which covers that child as a depe~de~t of the step-pare~t will be deter'mined befot'e the berlefits IJf a Play, which C'Jvers that child dS a dependent of the p¿rent without custody. rci notwithstanding subparagraphs (a) and (b) of this paragraph, when the pat'erlts ar'e di vot"ced 'Jr sepat'ated arid there is a clJurt decr'ee which would otherwise establish financial responsibility for the medical, dental, I;)r IJther health care expenses with respect tQ the child, the benefits of a Plan which covers the child as a dependent of the parent with such fina~cial respo~sibility shall be determined befot'e the benefits I:.f any either Plan which covers the child as a dependent child. When paragr~phs (1) and (2) do not establish an order of benefits determination, the benefits of a Plan which has covered the person o~ whose expenses claim is based for the l,::.nget' per'iod of time shall be determined before the benefits of a Plan which has covered such person the shorter period of time, except that: ( d) the ben~fit~ or ð Plan covering the person on whose expenses claim is based as a laid-off or retired employee or as the depender-It I:,f such pet'sl::.n shall be determined after' the benefits of any othe~ Plan covering such person as an employee other than as a laid-off or retired employee or a dependent of such person. (b) if either Pla~ does not have a provision regarding laid-off or retired employees, and, as a result, each Pla~ determines its benefits after the other, then the provisions of subparagraph (a) do not apply. . Health Plan shall be entitled to: ( 1 ) GM-12-11 DeterMine whether and to what extent a Covered Person has indemnity or other' cc>vet'."ye f.:¡t' the Health Set'vices pt'ovided ¡.\ridet' this Contt'act;