Coordinating benefits is common with health and dental plans; it allows employees and their dependents to make the most of their plans by combining benefits to receive 100% coverage on prescriptions and/or health and dental procedures.
If an employee and his/her spouse both have coverage, the claims should go through the patient's plan first. Any expenses that are not covered by the patient's plan can then be submitted to the spouse's plan along with an explanation of benefits from the initial claim.
If the employee and his/her spouse have dependants, the claim goes through the plan of the parent whose birthday falls earlier in the calendar year, then to the other parent along with an explanation of benefits.
When parents are divorced or separated, the dependant'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
Coordinating benefits can help employees to save money on health and dental claims and ensure that they are receiving the most amount of coverage available to them.