Determining primary coverage and reductions to primary

Priority Health follows this process to determine the order of benefit.

Primary: Benefits are determined first ("primary") under the plan covering the claimant as an employee. If the claimant is covered under more than one plan as an employee, the benefits of the plan which has been in effect the longest period of continuous coverage is primary.

Secondary: If the claimant is covered under one plan as an employee and under a second plan as a dependent, the dependent plan benefits are determined second.

Dependent children
Benefits for dependent children are determined first under the plan of the parent whose birthday occurs earlier in the year (Birthday Rule).

Determining primary for children of divorced/separated natural parents

In most cases, benefits are determined in this order:

1. The plan of the parent with custody.
2. If the parent with custody has remarried, the plan of the spouse with custody.
3. The plan of the parent without custody, and lastly
   
4. If the parent without custody has remarried, the plan of the spouse without custody.

One parent responsible
If the specific terms of the court order or divorce decree state that one parent is responsible for the health care expenses of the child, benefits are determined in this order:

1. The plan of the parent designated by court order, then
2. The plan of the other natural parent.

Joint responsibility
If the specific terms of the court order or divorce decree state that parents share joint custody, without designating financial responsibility to either parent, the Birthday Rule (see Dependent children above) applies.