What Else Do I Need to Know? Property of Bind Benefits, Inc., d/b/a Surest. All rights reserved © 2026. 79 F. Custodial Parent. Custodial Parent is 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. What Are the Rules for Determining the Order of Benefit Payments? 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 under any other Plan. B. Except as provided in the next paragraph, a Plan that does not contain a coordination of benefits provision that is consistent with this provision is always primary unless the provisions of both Plans state that the complying Plan is primary. 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 in excess of any other parts of the Plan provided by the contract holder. Examples of these types of situations are major medical coverages that are superimposed over base plan hospital and surgical benefits, and insurance type coverages that are written in connection with a Closed Panel Plan to provide out-of-network benefits. C. A Plan may consider the benefits paid or provided by another Plan in determining 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: 1. Employee/Retiree or Dependent. The Plan that covers the person as an employee, Participant, policyholder, subscriber, or retiree is the Primary Plan and the Plan that covers the person as a dependent is the Secondary Plan. However, if the person is a Medicare beneficiary and, as a result of federal law, Medicare is secondary to the Plan covering the person as a dependent and primary to the Plan covering the person as an employee, Participant, policyholder, subscriber, or a retired employee, then the order of benefits between the two Plans is reversed so that the Plan covering the person as an employee, Participant, policyholder, subscriber, or retiree is the Secondary Plan and the other Plan is the Primary Plan. 2. Dependent Child Covered Under More Than One Coverage Plan. Unless there is a court decree stating otherwise, Plans covering a dependent child shall determine the order of benefits as follows: a) For a dependent child whose parents are married or are living together, whether or not they have ever been married: (1) The Plan of the parent whose birthday falls earlier in the calendar year is the Primary Plan. (2) If both parents have the same birthday, the Plan that covered the parent longest is the Primary Plan.