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Determining Which Plan Pays First

SAIC uses the following insurance industry guidelines for determining the primary and secondary payers for employees and dependents.

Employees

The plan that covers the participant as an employee is the primary payer. The plan that covers the participant as a dependent is the secondary payer.

Dependents

For an employee's spouse or registered domestic partner, a plan that covers him or her as an employee is the primary payer for his or her claims. If an employee has elected coverage for his or her spouse or registered domestic partner as a dependent and he or she has coverage through another employer, the SAIC medical plan is the secondary payer.

For an employee's dependent children, the plan of the parent whose birthday occurs first in the calendar year is usually the primary payer. If the plan of an employee's spouse or registered domestic partner plan does not follow this "birthday rule," then the "gender rule" applies. That is, the plan covering the child's father as an employee pays first.

In the case of divorced or separated parents, benefits are determined in the following order:

The plan of the parent who has financial responsibility by court decree;
The plan of the stepparent who is the spouse of the parent who has custody of the child; and
The plan of the parent who does not have custody of the child.

When none of these rules establishes order, benefits are paid first by the plan that has covered the person for the longer period of time. An exception is a plan that covers a laid-off or retired employee. That plan is secondary to a plan that covers a person as an active employee.

Following is an example of how benefits are paid depending on whether SAIC plans are primary or secondary. Deductible and coinsurance amounts are for illustrative purposes only. A participant's plan may have other levels of payment.

Determining Which Plan Pays First
IF THE SAIC PLAN IS PRIMARY. . .		IF THE SAIC PLAN IS SECONDARY. . .
Eligible Expenses	$1,200	Eligible expenses	$1,200
Deductible	-$250	Primary plan paid	- $720
	= $950	The plan pays (assuming deductible has been met and network coinsurance is 85%)	= $300
Network Coinsurance	x 85%
The plan pays	= $807.50