Maximize your Coverage
It is possible for you to be covered under more than one benefit plan. For example you might:
- Have your own coverage through your employer as well as being covered under your spouse’s plan
- Have your own student coverage as well as dependent coverage under one or both of your parents’ plans
Health and Dental benefits payable can be coordinated between comparable plans to receive up to 100% coverage for eligible expenses
Three simple steps to maximize your coverage by coordinating your benefits:
Submit claims to your own plan first.
Then submit the claims to the coordinating plan (include the Claim Statement / Explanation of Benefits from the first plan).
Common Scenarios
Important: Always submit to your own employee plan first
After submitting to your own plan first, then submit your claim with any remaining balance along with an Explanation of Benefits to your coordinating plans.
If your child/dependent is submitting a claim…
Primary
1st
Secondary
2nd
Parent / Guardian with an earlier birthday i.e., March 3rd
Parent / Guardian with the later birthday i.e., May 5nd
What you should do:
Submit the claim to the parent whose birthday (MM/DD) comes first in the calendar year.
If both parents have the same birth date, submit the claim to the plan of the parent whose first name begins earlier in the alphabet.
If you are separated/divorced with a child/dependent submitting a claim…
Scenario: You are separated/ divorced, and have a dependent eligible under both parent’s plans.
1st
Secondary
2nd
Tertiary
3rd
Parent / Guardian with primary custody
Spouse of Parent / Guardian with primary custody
Parent / Guardian with secondary custody
What you should do:
Submit first to the plan of the parent with primary custody.
Next the plan of the spouse of the parent with primary custody.
Next the plan of the parent with secondary custody.
If you have more than 1 job/ benefit plan and are submitting a claim…
Scenario: You have 2 jobs and have coverage with both employers.
1st
2nd
Full-Time employment (or job you started working at first)
Part-Time employment (or retiree plan)
What you should do:
Submit first to the full-time benefits plan or the job you started working at first,
Then the other benefits plan.
If you have a retiree plan:
Submit first to your current full-time employment benefits.
Then part-time employment benefits.
Then the retiree plan.
Coordination of Benefits can be complicated between blended and split families.
If you have questions regarding how it applies to your specific circumstances please Contact Us.