Common use of Dependent Child/Separated or Divorced Clause in Contracts

Dependent Child/Separated or Divorced. If two or more plans cover a person as a dependent child of divorced or separated parents, benefits for the child are determined in this order: (a) first, the plan of the parent with custody of the child; (b) then, the plan of the spouse of the parent with the custody of the child; and (c) finally, the plan 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 health care expense of the child, and the entity obligated to pay or provide the benefits of the plan of that parent has actual knowledge of those terms, the benefits of that plan are determined first. The plan of the other parent shall be the Secondary Plan. This paragraph does not apply with respect to any Claim Determination Period or Plan Year during which any benefits are actually paid or provided before the entity has that actual knowledge.

Appears in 19 contracts

Sources: Membership Contract, Membership Contract, Membership Contract

Dependent Child/Separated or Divorced. If two or more plans cover a person as a dependent child of divorced or separated parents, benefits for the child are determined in this order: (a) first, the plan of the parent with custody of the child; (b) then, the plan of the spouse of the parent with the custody of the child; and (c) finally, the plan 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 health or dental care expense of the child, and the entity obligated to pay or provide the benefits of the plan of that parent has actual knowledge of those terms, the benefits of that plan are determined first. The plan of the other parent shall be the Secondary Plan. This paragraph does not apply with respect to any Claim Determination Period or Plan Year calendar year during which any benefits are actually paid or provided before the entity has that actual knowledge.

Appears in 3 contracts

Sources: Dental Benefit Plan, Dental Benefit Plan, Dental Benefit Plan

Dependent Child/Separated or Divorced. If two or more plans cover a person as a dependent child of divorced or separated parents, benefits for the child are determined in this order: (a) first, the plan of the parent with custody of the child; (b) then, the plan of the spouse of the parent with the custody of the child; and (c) finally, the plan 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 health medical care expense of the child, and the entity obligated to pay or provide the benefits of the plan of that parent has actual knowledge of those terms, the benefits of that plan are determined first. The plan of the other parent shall be the Secondary Plan. This paragraph does not apply with respect to any Claim Determination Period or Plan Year calendar year during which any benefits are actually paid or provided before the entity has that actual knowledge.

Appears in 2 contracts

Sources: Medical Benefit Plan, Medical Benefit Plan

Dependent Child/Separated or Divorced. If two or more plans cover a person as a dependent child Child of divorced or separated parents, benefits for the child Child are determined in this order: (a) first, the plan of the parent with custody of the childChild; (b) then, the plan of the spouse Spouse of the parent with the custody of the childChild; and (c) finally, the plan of the parent not having custody of the childChild. However, if the specific terms of a court decree state that one of the parents is responsible for the health or dental care expense of the childChild, and the entity obligated to pay or provide the benefits of the plan of that parent has actual knowledge of those terms, the benefits of that plan are determined first. The plan of the other parent shall be the Secondary Plan. This paragraph does not apply with respect to any Claim Determination Period or Plan Year calendar year during which any benefits are actually paid or provided before the entity has that actual knowledge.

Appears in 1 contract

Sources: Dental Benefit Plan