58-18A-70. Plan covering dependent child.
Unless there is a court decree stating otherwise, plans covering a dependent child shall determine the order of benefits as follows:
(1)For a dependent child whose parents are married or are living together, whether or not they have ever been married:
(a)The plan of the parent whose birthday falls earlier in the calendar year is the primary plan; or
(b)If both parents have the same birthday, the plan that has covered the parent longest is the primary plan;
(2)For a dependent child whose parents are divorced or separated or are not living together, whether or not they have ever been married:
(a)If a court decree states that one of the parents is responsible for the dependent child's health care expenses or health care coverage and the plan of that parent has actual knowledge of those terms, that plan is primary. If the parent with 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 item does not apply with respect to any plan year during which benefits are paid or provided before the entity has actual knowledge of the court decree provision;
(b)If a court decree states that both parents are responsible for the dependent child's health care expenses or health care coverage, the provisions of subdivision (1) of this section shall determine the order of benefits;
(c)If a court decree states that the parents have joint custody without specifying that one parent has responsibility for the health care expenses or health care coverage of the dependent child, the provisions of subdivision (1) of this section shall determine the order of benefits; or
(d)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:
(i)The plan covering the custodial parent;
(ii)The plan covering the custodial parent's spouse;
(iii)The plan covering the noncustodial parent; and then
(iv)The plan covering the noncustodial parent's spouse;
(3)For a dependent child covered under more than one plan of individuals who are not the parents of the child, the order of benefits shall be determined, as applicable, pursuant to subdivision (1) or (2) of this section as if those individuals were parents of the child; and
(4)For a dependent child who has coverage under either or both parents' plans and also has his or her own coverage as a dependent under a spouse's plan, the provisions of §58-18A-73 apply. If the dependent child's coverage under the spouse's plan began on the same date as the dependent child's coverage under either or both parents' plans, the order of benefits shall be determined, as applicable, pursuant to the provisions of subdivision (1) of this section to the dependent child's parent or parents and the dependent's spouse.
Source: SL 2006, ch 259, §18; SL 2015, ch 253, §2.
Structure South Dakota Codified Laws
Chapter 18A - Coordination Of Benefits Of Health Plans
Section 58-18A-53 - Definitions.
Section 58-18A-54 - Allowable expenses defined.
Section 58-18A-55 - Expenses that are not allowable.
Section 58-18A-56 - Exclusion of certain expenses.
Section 58-18A-58 - Contracts and coverages included within definition of plan.
Section 58-18A-59 - Contracts and coverages not included within definition of plan.
Section 58-18A-60 - Application date.
Section 58-18A-61 - Promulgation of rules concerning coordination of health plan benefits.
Section 58-18A-62 - Prohibited grounds for reduction of benefits.
Section 58-18A-63 - Restriction on excess or secondary benefits provisions.
Section 58-18A-64 - Closed panel plans.
Section 58-18A-65 - Prohibition on reduction of benefits for coverage not qualifying as plan.
Section 58-18A-66 - Order of benefit payments.
Section 58-18A-67 - Coordination of benefits only available to secondary plans.
Section 58-18A-68 - Order of benefits determined under §§ 58-18A-69 to 58-18A-74.
Section 58-18A-69 - Plan covering person other than as dependent.
Section 58-18A-70 - Plan covering dependent child.
Section 58-18A-71 - Plan covering person as active employee.
Section 58-18A-72 - Coverage under COBRA or right of continuation.
Section 58-18A-73 - Plan covering person for longer period of time.
Section 58-18A-74 - Sharing of allowable expenses equally.
Section 58-18A-75 - Calculation of amount to be paid by secondary plan.
Section 58-18A-76 - Plan providing benefits as services.
Section 58-18A-77 - Coordination of benefits of complying and noncomplying plans.
Section 58-18A-79 - Subrogation distinguished.
Section 58-18A-80 - Paying of claim where plans disagree on order of benefits.
Section 58-18A-81 - Time for bringing existing contract into compliance with statutory requirements.
Section 58-18A-82 - Proceedings not subject to statutory requirements.
Section 58-18A-83 - Duties, rights accrued, and offenses committed prior to July 1, 2007.