Georgia – CoB reversing primary and 2nd due to custody

My children have been dually insured under the same 2 polices for several years. One with my ex, one with my husband. Georgia rules and regulations pretty much follow NAIC guidelines. My ex and I have had "joint legal custody" the entire time, with me being "primary physical custodian" most of the time. My understanding of GA custody law is that a physical custodian has to be assigned even if the child spends equal time at both homes. My original divorce decree states that my ex is "responsible for maintaining the health insurance policy for the minor children" and costs not covered will be split equally.

My ex's policy has always been primary. His birthday also comes before both mine and my husband's. The primary policy is suddenly saying that they are reversed, and is sending notifications to providers wanting their money back who are then calling me. They are spitting back claims as far back as last August that I know of so far.

Last summer I submitted the most recent physical custody modification to my ex's policy so that they were allowed to speak to me regarding my son's claims. This is likely where it started. They do not have the original decree stating that my ex is ordered to carry coverage, but I will be sending it to them.

My ex's plan's policy documents (below) mirror the state regulatory language. Our policy documents (federal) follow NAIC guidelines which reflect the same:

• Dependent Child/Parents Separated or Divorced – If two or more plans cover a person as a Dependent child of divorced or separated parents, Benefits for the child are determined in this order: 1. the plan of the parent with custody of the child; 2. the plan of the spouse of the parent with custody of the child; and 3. the plan of the parent not having custody of the child. However, if the specific terms of a court decree state that one of the parents is responsible for the child’s health care expenses, and the company obligated to pay or provide the Benefits of the plan of that parent has actual knowledge of those terms, the Benefits of that plan are determined first. This paragraph does not apply with respect to any claim determination period or plan year during which any Benefits are actually paid or provided before the company has that actual knowledge. • Joint Custody – If the specific terms of a court decree state that the parents shall have joint custody, (without stating that one of the parents is responsible for the health care expenses of the child), the plans covering the child shall follow the order of benefit determination rules outlined above for “Dependent Child/Parents not Separated or Divorced.”

I feel like their determination is inaccurate, but more so, I read the above rules to say that they can't go back to previous years, or switch the order mid-year. Is that not what it means?

I actually benefit from having our policy as primary, so I have no problem with them switching it, aside from the fact that it's creating a huge complicated mess.

I tried to call the state insurance commissioner's office to get clarification of the language, only to find out that this is the state employee health plan, and they essentially regulate themselves.

ex's plan documentation – previously primary

husband's plan documentation – previously secondary

submitted by /u/Doll-Dagga-BuzzBuzz
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