Orange County NC Website
46 <br /> SECTION X <br /> COORDINATION OF BENEFITS <br /> If a subscriber or a Family Dependent is covered by a Group Benefit Plan <br /> through employment, the Plan's coverage and that of the other Group <br /> Benefit Plan will coordinate so that up to, but no more than, 100% of <br /> any Covered Services will be considered in accordance with this Contract. <br /> The Plan will process claims first only if it is the primary <br /> carrier. If another carrier is primary, the Plan will process the <br /> balance remaining after the primary carrier has completed process, <br /> • <br /> provided in Explanation of Benefits (BOB) statement is submitted to <br /> the Plan. <br /> The Plan will decide if it or the other Group Benefit Plan should <br /> cover or pay for the Health Services based on the order of the following <br /> rules: <br /> 1. The group plan that does not have a Coordination of Benefits <br /> clause will have primary liability. <br /> 2. The plan which covered the person as other than a dependent <br /> will, have primary liability. <br /> 3. The Plan covering the person whose month and date of birth is <br /> • earliest in a calendar year shall be primary for a <br /> dependent(s) (excluding the year of birth). <br /> 4. When the parents are separated or divorced and the parent <br /> with custody of the child has not remarried, the benefits of <br /> the plan which covers the child as a dependent of the parent <br /> with custody of the child will be determined before the <br /> benefits of the plan which covers the child as a dependent of <br /> the parent without custody <br /> 5. When the parents are divorced and the parent with custody of <br /> • <br /> 41 <br />