Is there a document that shows how the birthday rule works when the parents are divorced.?

Question

Mother has primary, but they share joint legal and physical.

I keep reading that court order will over rule the birthday rule that goes by month not year. Spouse ex wife wants us to take the child off Kaiser but all we need is court order to make her Blue Cross primary, as she also has primary custody? Is that correct?

Answer 1

You need to get a copy of the Summary Plan Description from both companies.  It should be a relatively long document with multiple pages that spell out the fine details of your insurance.

Most of the time, SPD's only follow the birthday rule if there is no court order specifying who is primary and who is secondary - so it is possible that the birthday rule gets over-ridden by an order from the judge.

Usually HR departments of employers have a copy somewhere.  If you call the insurance company I know you can get one from there too, but you will probably get transferred a lot, get referred around, because full SPD's are a pain in the butt to get ahold of.  But they do exist.  They have to.

Answer 2

I don't know what state you're in, but here's a link from the Illinois Department of Insurance that spells out how Coordination of Benefits rules work:

http://www.idfpr.com/DOI/HealthInsurance...

Even though this is an Illinois link, the rules are industry standard and pretty much the same everywhere.  If you wish, you may be able to locate the same/similar information  on your own state's Department of Insurance website.

It is correct that for children of divorced parents, a court order could override normal COB rules.  Hopefully the above link can help you figure out what applies in your situation.