SSMC Employee Health Benefit Plan
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c. Health Claims for Dependent Child. The order of benefit determination is based on the earliest
birthday (month/day) of the child's parents. The plan(s) of the parent with the earliest birthday pays
before the plan(s) of the parent with the later birthday. As your Spouses birthday (June 15) is the
earliest date, the order of benefit is:
XYZ Inc. active plan of Spouse pays first.
SSMC active Plan pays second.
ABC Mfg. retired plan pays last.
The above order of benefit applies to children whose parents are not separated or divorced.
4. I am eligible for SSMC Plan continuation coverage under COBRA. I am also eligible under the retiree
Plan of my Spouse through XYZ, Inc.
Continuation coverage pays after other Plans.
XYZ, Inc. Plan pays first.
SSMC Plan continuation under COBRA pays last.
5. I am eligible for SSMC benefits as an Employee. My Spouse is eligible for benefits through his or her
employer, XYZ Inc. We both include our Spouse as an Eligible Dependent. My Spouse is eligible for
Medicare due to end stage renal disease. What is the order of benefit determination for my Spouse's
claims?
Current Medicare Secondary Payer rules establish the employer health plans as primary payer for the
first 30 months of Medicare Eligibility due to end stage renal disease. Medicare becomes primary
payer after the first 30 months.
The order of benefit determination for the first 30 months would be
XYZ Inc. Spouse's plan pays first.
SSMC Plan pays second.
Medicare pays last.
The order of benefit determination after 30 months would be
Medicare pays first.
XYZ Inc. Spouse's plan pays second.
SSMC pays last.
