Coordination of benefits

BP's Dental Program coordinates with other dental coverage in which you may participate
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Dental PPO

If you have dental coverage in addition to the Dental PPO, coverage under the Dental PPO is subject to coordination of benefit (COB) rules.

COB rules prevent a duplication or double payment of a provider’s charges for services. Under COB rules, the combined dental coverages pay up to, but not more than, 100% of covered expenses. You may never receive more than the actual charges.

COB rules generally apply to group insurance plans, no fault auto insurance and Medicare. Under COB, one plan is primary and the other plan is secondary. In some instances, you may also have a third plan, which is known as tertiary. When a claim is made, the primary plan pays its benefits without any consideration to the secondary or tertiary plans. The secondary plan adjusts its benefits so that the total benefits paid by both plans will not be more than the total covered expenses.

The following rules determine which plan is primary:

  • A plan that does not coordinate benefits is the primary plan and determines its benefits first.
  • If all plans coordinate benefits, the BP plan is the primary plan for an active employee.
  • If you have COBRA coverage under the BP plan and other group health coverage, the BP plan will not be the primary plan.
  • If your spouse/domestic partner is enrolled in his/her employer-sponsored plan as an active employee, a COBRA participant or a retiree, that plan is the primary plan for him/her.
  • If your children are covered by both the BP plan and your spouse’s/domestic partner’s employer-sponsored plan, a rule known as the “birthday rule” will be applied to determine the order of benefit payments. Under this rule, the plan of the parent whose month and day of birth is earlier in the calendar year (not necessarily the older parent) is the primary plan. If both parents have the same birthday, the plan that has had coverage in effect longer is the primary plan.
  • If you are separated or divorced and your children are covered by more than one group health plan:
    • The plan of the natural parent with custody is the primary plan.
    • The plan of the spouse/domestic partner of the natural parent with custody is the secondary plan.
    • The plan of the other natural parent is the tertiary plan.
  • If the natural parent without custody has legal financial responsibility for the child’s dental care, the plan of that parent becomes the primary plan.

With coordination of benefits, if the BP plan is the secondary (or tertiary) plan and another plan covering you or a covered dependent is the primary plan, it is possible that the BP plan will not pay any benefits if the primary plan’s benefits are in all cases equal to or better than the BP plan's benefits.

DHMO

If you are enrolled in the DHMO, call Cigna Dental Health for information about how that plan coordinates benefits.

 

Publication date: April 2019

 

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