Coordination of Benefits
Delta Dental of Tennessee October 14, 2018
Coordination of Benefits is a procedure for paying health care expenses when people are covered by more than one dental plan. The goal of coordinating benefits is to make sure the cost of the dental procedure is covered within the scope of the plans, without exceeding the amount of the actual bill.
If you are covered by two or more dental plans—usually because both you and your spouse receive coverage through work—your coverage will be coordinated.
For children covered by both parents’ (or guardians’) dental plans, the primary carrier is determined by the “birthday rule.” The plan that covers the parent or guardian whose birthday comes first in the calendar year will be considered the primary carrier. The birthday rule may be superseded by a divorce judgment or court ruling.
If a dependent, such as a spouse or child, has dental coverage through a company other than Delta Dental and that company does not cover the full cost of a dental visit or procedure, your dependent may be eligible to receive reimbursement for part or all of the coverage from Delta Dental, provided that your dependent is also covered by your plan.