Coordination of Benefits FAQs

We are frequently asked for the correct way to coordinate benefits (when a patient is covered by two or more dental benefits plans). Delta Dental's Claims Department provides the following tips, which apply in the vast majority of coordination of benefits situations:

• The benefits of the plan that covers the covered person as an employee, member, subscriber or retiree is determined before those of the plan that covers the covered person as a dependent.

• Coordination of dental benefits for dependents usually (but not always) follows the birthday rule. This means that the dental plan for the parent whose birthday (month and day) is earlier in the calendar year provides the primary coverage. (Delta Dental has a small number of groups that determine the primary carrier by the gender rule.)

• In cases of divorce, if the responsibility is not detailed in the divorce decree, the parent with custody is usually primary, the stepparent is usually secondary and the non-custodial parent is usually tertiary (third). If the parents have joint custody, then the parent with the birthday earlier in the calendar year usually has primary coverage, unless stated otherwise.

• For certain oral surgery and some periodontal surgery procedures, the medical plan is the primary plan when those procedures are covered under that plan, unless otherwise agreed upon by the contract holder.

• For coordination of benefits when there are two medical and two dental plans (for example, an eligible dependent): Subscriber A is the parent whose birthday month and day is first in the calendar year. Subscriber A's medical plan would be primary, and then Subscriber A's dental plan would be secondary. Subscriber B is the parent whose birthday month and day is second in the calendar year. Subscriber B's medical plan would be third, and Subscriber B's dental plan would be fourth.

• The benefit of the plan that covers the covered person as an employee, member, subscriber or retiree, or dependent of such person, shall be determined before those of the plan that covers them under a right of continuation (such as COBRA) pursuant to federal or state law.