Minnesota Legislature
Office of the Revisor of Statutes
Minnesota Administrative Rules
4685.0915 COORDINATION OF BENEFITS; PROCEDURES.
Subpart 1.
General.
The general order of benefits is as follows:
A.
The primary plan must pay or provide its benefits as if the secondary plan or plans do not exist. A plan that does not include a coordination provision may not take into account the benefits of another plan as defined in part 4685.0910 when it determines its benefits. The one exception is that a contract holder's coverage designed to supplement a part of a basic package of benefits may provide that the supplementary coverage shall be excess to any other parts of the plan provided by the contract holder.
B.
A secondary plan may take the benefits of another plan into account only when, under this part, it is secondary to that other plan.
C.
The benefits of the plan that covers the person as an employee, member, or subscriber, that is, other than as a dependent, are determined before those of the plan that covers the person as a dependent.
Subp. 2.
Dependent child: parents not separated or divorced.
Benefits for a dependent child when the parents are not separated or divorced must be coordinated according to the procedures in items A to E.
A.
The benefits of the plan of the parent whose birthday falls earlier in a year are determined before those of the plan of the parent whose birthday falls later in that year.
B.
If both parents have the same birthday, the benefits of the plan that covered the parent longer are determined before those of the plan that covered the other parent for a shorter time.
C.
The word "birthday" refers only to month and day in a calendar year, not the year in which the person was born.
D.
A group contract that includes coordination of benefits and is issued or renewed or that has an anniversary date on or after 60 days after October 9, 1989, must include the substance of the provisions in items A to C. Until October 9, 1989, the group contract may contain wording such as: "Except as stated in subpart 3, the benefits of a plan that covers a person as a dependent of a male are determined before those of a plan that covers the person as a dependent of a female."
E.
If one parent's plan contains the coordination plan described in items A to C, and the other parent's plan contains the coordination plan based on the gender of the parent, and if, as a result, the parents' plans do not agree on the coordination of benefits, the coordination plan based on the gender of the parent determines the order of benefits.
Subp. 3.
Dependent child: separated or divorced parents.
If two or more plans cover a person as a dependent child of divorced or separated parents, benefits for the child are coordinated according to this subpart. If a court orders one of the parents to pay the health care expenses of the child, and the entity that pays or provides the parent's plan knows of the order, the benefits of that parent's plan are determined first. The plan of the other parent is the secondary plan. This paragraph does not apply to any claim determination period or plan year during which benefits are actually paid or provided before the entity knows of the order. If a court order does not require one of the parents to pay the child's health care expenses, benefits are coordinated according to items A to C.
B.
The benefits of the plan of the spouse of the parent with the custody of the child are determined second.
Subp. 4.
Active/inactive employee.
The benefits of a plan that covers a person as an employee, who is neither laid off nor retired, or as a dependent of that employee are determined before benefits of a plan that covers that person as a laid-off or retired employee or as a dependent of that employee. If the other plan does not have this rule and if, as a result, the plans do not agree on the order of benefits, this rule does not apply.
Subp. 5.
Longer/shorter length of coverage.
If none of these rules determines the order of benefits, the benefits of the plan that covered an employee, member, or subscriber longer are determined before those of the plan that covered that person for the shorter term.
A.
To determine the length of time a person has been covered under a plan, two plans are treated as one if the claimant was eligible under the second plan within 24 hours after the first ended.
B.
The start of a new plan does not include:
(3)
a change from one type of plan to another, such as from a single employer plan to that of a multiple employer plan.
C.
The claimant's length of time covered under a plan is measured from the claimant's first date of coverage under that plan. If that date is not readily available, the date the claimant first became a member of the group is the date used to determine the length of time the claimant's coverage under the present plan has been in force.
History:
14 SR 901
Published Electronically:
October 11, 2007
Official Publication of the State of Minnesota
Revisor of Statutes