Section 760 IAC 1-38.1-14 - Order of benefits for dependent child/separated or divorced parentsAuthority: IC 27-1-3-7
Affected: IC 27-8-5-19
Sec. 14.
(a) For a dependent child whose parents are divorced or separated or do not live together, whether or not they have ever been married, this subsection applies: (1) If there is no court decree allocating responsibility for the child's health care expenses or health care coverage, the order of benefits for the child are as follows: (A) The plan of the custodial parent.(B) The plan of the spouse of the custodial parent.(C) The plan of the noncustodial parent.(D) The plan of the spouse of the noncustodial parent.(2) If the:(A) specific terms of a court decree state that one (1) of the parents is responsible for the health care expenses of the child; and(B) entity obligated to pay or provide the benefits of the plan of that parent has actual knowledge of those terms; that plan is primary. If the parent with the responsibility has no health care coverage for the dependent child's health care expenses, but that parent's spouse does, that parent's spouse's plan is the primary plan. This subsection does not apply with respect to any claim determination period or plan year during which any benefits are actually paid or provided before the entity has that actual knowledge.(3) If the specific terms of a court decree state that both parents are responsible for the dependent child's health care expenses or health care coverage, the provisions of section 13 of this rule shall determine the order of benefits.(4) If a court decree states that the parents have joint custody without specifying that one (1) parent has responsibility for the health care expenses or health care coverage of the dependent child, the provisions of section 13 of this rule shall determine the order of benefits.(b) For a dependent child covered under more than one (1) plan of individuals who are not the parents of the child, the order of benefits shall be determined as applicable under section 13 of this rule as if those individuals were parents of the child.Department of Insurance; 760 IAC 1-38.1-14; filed Feb 14, 1990, 3:30 p.m.: 13 IR 1173; readopted filed Sep 14, 2001, 12:22 p.m.: 25 IR 531; filed Sep 15, 2006, 2:02 p.m.: 20061011-IR-760050265FRA; readopted filed Nov 21, 2012, 4:15 p.m.: 20121219-IR-760120454RFAReadopted filed Nov 13, 2018, 10:02 a.m.: 20181212-IR-760180372RFA