Receiving Your Benefits

Coordination of Benefits

Many individuals have dental coverage in addition to their coverage under the University dental plan. For example, you may be covered as a dependent under your spouse’s dental plan. This coordination of benefits provision prevents duplication of benefit payments when you or your dependent(s) also have coverage through another group plan. Coordination of benefits procedures also determines which plan pays first.

How Coordination of Benefits Works

The first step in coordinating benefits between two or more group plans is to determine which plan is primary and which plan is secondary. The primary plan pays benefits first. The secondary plan then pays its benefits so that the total benefit paid from both plans is not more than 100% of the allowable expense. No plan pays more than it would pay without coordination of benefits.

Order of Coverage

If you are covered as an employee by one plan and as a dependent by another, the plan that covers you as an employee pays benefits first.

If your child is covered under both your and your spouse’s dental plan, the plan of the parent whose birthday comes first during the calendar year is the child’s primary dental plan. If two or more dental plans cover a dependent child of divorced or separated parents, benefits for the child are determined as follows:

First, the dental plan of the parent who has a court decree of financial responsibility will be primary.

If no such court decree exists, then the dental plan of the parent who has custody of the child will be primary.

Then, the dental plan of the spouse of the parent who has custody of the child will be primary.

Finally, the dental plan of the parent who does not have custody of the child will be primary.

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.