2 Alaska Admin. Code § 39.915

Current through May 31, 2024

Section 2 AAC 39.915 - Coordination of benefits

(a) Beginning July 1, 2004, all plans covering state employees to which the state contributes must coordinate benefits as provided in this section.

(b) A plan without coordination provisions is always the primary plan.

(c) If all plans have a coordination provision, the primary plan must be determined in the following order:

(1) first, any active plan, whether it covers the employee or a dependent, is the primary plan over Medicare;

(2) second, the plan covering the employee directly, rather than as a dependent, is the primary plan;

(3) third, the plan covering the employee as an active employee, rather than as a laid-off or retired employee, is the primary plan;

(4) fourth, the plan that has covered the employee longer is the primary plan.

(d) If a child is covered under both parents' plans, the plan of the parent whose birthday falls earlier in the year is the primary plan for the child. If both parents have the same birthday, the plan that has covered a parent longer is the primary plan for the child.

(e) Notwithstanding (d) of this section, if an employee is separated or divorced, the plans pay in the following order:

(1) first, the plan of the parent whom a court of competent jurisdiction has established as financially responsible for the health care of a child who is otherwise eligible for coverage as a dependent child under the plan, if the administrator of the plan is notified of the order;

(2) second, the plan of the parent with custody of the child;

(3) third, the plan of the spouse of the parent with custody of the child;

(4) fourth, the plan of the parent who does not have custody of the child;

(5) fifth, the plan that has covered the child longer.

(f) An employee covered by a plan under this section must report the existence of any plan, or the benefits payable to the employee under any plan.

(g) If a plan provides benefits in the form of services rather than cash payments, the reasonable cash value of each service rendered is considered a covered service and a benefit paid. The reasonable cash value of any services provided is considered an expense incurred by the employee or the employee's covered dependent, and the liability under the secondary plan is reduced accordingly.

2 AAC 39.915

Eff. 7/1/2003, Register 166

Authority:AS 39.30.090

AS 39.30.091