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

Always submit to your own employee 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…

Scenario: Your dependent child has coverage under both yours and your partner’s benefit plans.

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.

Primary
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.

Primary
1st



Secondary
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.