Priority Health follows this process to determine the order of benefit.
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.
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.
Benefits for dependent children are determined first under the plan of the parent or step-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 by factors in this order:
- 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.
- The plan of the parent with custody.
- If the parent with custody has remarried, the plan of the spouse with custody.
- The plan of the parent without custody, and lastly
- If the parent without custody has remarried, the plan of the spouse without custody.