Coordinating Health and Dental Benefits

In many cases, getting the highest coverage may mean coordinating benefits with other insurance plans. Coordinating benefits is common with dental and drug claims, and happen if an employee or a dependent is covered under your group insurance plan and under a spouse's program. In this case, the two plans may combine to pay up to 100% of the claim expenses . 

When both spouses have coverage, claims should go to the patient's plan first. Any expenses not covered by the patient's plan should then be submitted to the spouse's plan along with the Explanation of Benefits from the initial claim. 

For dependent's benefits, the claim goes through the plan of the parent whose birthday falls earlier in the calendar year, then to the spouse's plan along with the Explanation of Benefits. 

When parents are separated or divorced, dependent's claims should be submitted in this order:

  • The plan of the parent with custody
  • The spouse of the parent with custody 
  • The parent who does not have custody 
  • The spouse of the parent who does not have custody

Remember to make photocopies of all documents before you send them to each plan. By coordinating benefits, you can ensure your employees are making the most of their benefit plans.