The following are the provisions for determining which plan will be "primary":
Description | Primary Plan | Secondary Plan |
|---|---|---|
Active employee | Plan that has been in effect the longest | n/a |
Active employee with COBRA from previous employer | State and School Employees' Health Insurance Plan | COBRA |
Dependent spouse with other coverage as 'active employee' | Other health plan | State and School Employees' Health Insurance Plan |
Active employee and spouse with children: both parents' health plans cover children | Follow birthday rule* | Follow birthday rule* |
Active employee, divorced or separated, both parents' health plans cover children with court order | Follow court decree** | Follow court decree** |
*Under the birthday rule, the plan of the parent whose birthday falls earliest in the calendar year is the child's primary plan. If both parents have the same birthday, the parent who has been covered longer has the primary plan. If the non-MSSEHIP plan does not have the birthday rule, then the rule in the non-MSSEHIP plan will determine which is primary.
**If parents are divorced or separated, and both parents' plans cover a dependent child, and there is no court decree, benefits for the child are determined in this order:
First, the plan of the parent with custody;
Then, the plan of the stepparent (spouse of the parent with custody of the child);
Finally, the plan of the parent not having custody of the child.