Coordinating benefits

When two insurance plans work together to pay claims for the same person

If both you and your spouse have benefits plans (even if you are both in THIS plan), you can coordinate your benefits to ensure that you are getting the most from your coverage.

Here’s how it works.

You each submit your claims to your plan first, and then submit any unpaid amounts to your spouse’s plan. If you have claims for a dependent child, submit them first to the plan for the spouse whose birthdate is earlier in the calendar year, and then to the other spouse’s plan.

Keep in mind your total reimbursement cannot be more than 100% of the claim, and will be limited to the amount deemed “reasonable and customary” (R&C) for the type of claim. This means the expense will be reimbursed according to the normal range of fees for that medical or dental service in the specific geographical area. So, if the expense exceeds R&C limits, the total reimbursement from both plans would be less than 100% of the expense.

For everything you need to know about your benefits:

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