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25C - AGMT GROUP INSURANCE
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25C - AGMT GROUP INSURANCE
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Last modified
2/1/2018 7:02:12 PM
Creation date
2/1/2018 7:10:52 PM
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Template:
City Clerk
Doc Type
Agenda Packet
Agency
Personnel Services
Item #
25C
Date
2/6/2018
Destruction Year
2023
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(II) primary to the plan covering the person as other than a Dependent (for <br />example, a retired employee), <br />then the Benefits of the plan covering the person as a Dependent are determined <br />before the Benefits of the plan covering the person as other than a Dependent. <br />(b) The plan which covers a child as a Dependent of a parent whose birthday occurs <br />earlier In a calendar year Is primary over the plan which covers a child as a Dependent <br />of a parent whose birthday occurs later in a calendar year (except for a dependent <br />child whose parents are separated or divorced as described in (c) below). <br />(c) In the case of a dependent child whose parents are legally separated or divorced: <br />(I) If the parent with custody has not remarried, the plan that covers the child as a <br />Dependent of the parent with custody is primary over the plan which covers the <br />child as a Dependent of the parent without custody. <br />(II) If the parent with custody has remarried, the plan which covers the child as a <br />Dependent of the parent with custody Is primary over the plan which covers the <br />child as a Dependent of the step-parent, and the plan which covers the child as <br />a Dependent of the step-parent Is primary over the policy or plan which covers <br />the child as a Dependent of the parent without custody. <br />(iii) If there is a court decree that establishes financial responsibility for dental <br />services which are Benefits under this plan, then notwithstanding (1) and (ii), <br />the plan which covers the child as a Dependent of the parent with such <br />financial responsibility is primary over any other plan which covers the child. <br />6.3 The Benefits of a plan covering a lald-off or retired employee (or Dependent of such person) <br />shall be determined after the Benefits of any other plan covering such person as an <br />employee. <br />6.4 If a person whose coverage is provided under federal or state law requiring continuation is <br />covered under more than one plan, Benefits order shall be determined as follows: <br />(a) The Benefits of the plan covering the person as an employee or Dependent shall be <br />primary. <br />(b) The Benefits under continuation coverage shall be secondary. <br />6.5 If the primary plan cannot be determined by the rules described in this Article 6, the plan that <br />has covered the person longer shall be primary. <br />6.6 An Enrollee will provide Delta Dental with any information about the person that Is needed to <br />administer this Article, and Delta Dental may release any information to or obtain any <br />information from any Insurance company or other organization in order to coordinate the <br />Benefits of an Enrollee. Delta Dental In Its sole discretion will determine whether any <br />reimbursement is warranted to an Insurance company or other organization under this <br />provision, and it is agreed that any such reimbursement paid by.Delta Dental will be Benefits <br />under this Contract. Delta Dental has the right to recover the value of any Benefits provided <br />by Delta Dental which exceed Its obligations under the terms of this provision from a Delta <br />Dental Dentist, Enrollee, Insurance company or other organization, as Delta Dental chooses. <br />25C-63 <br />
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