In addition to the drug, major medical and dental care benefits under this Plan, sometimes you or your dependents may be entitled to benefits for the same expenses under another insurance policy, or group or individual, or government sponsored plan. Should this type of duplication occur, the benefits under this Plan will be coordinated so that the total benefits from all plans will not exceed the expenses actually incurred. With each claim form you submit, you are required to confirm in writing whether or not coverage is available from another source.
Please note that it is your responsibility to make sure claims are submitted properly to our Plan. For example, if you or your spouse have coverage available from another source or benefit plan:
All of your claims must be sent to this Plan first
All of your spouse’s claims must be sent to his/her plan first.
Claims for dependent children go to the plan of the parent whose birthday occurs first in the calendar year. If your spouse’s birthday occurs first (for example April 12th) and your birthday is later (for example October 5th), then claims for your children must be sent to your spouse’s plan first. If both of you have the same birth date, then claims for your children must be sent to the plan of the parent whose first name begins with the letter that comes first in the alphabet.
If you are separated or divorced from the spouse with whom you had your dependent children, the claim should be sent to the plan of the parent with custody, then to his or her spouse’s plan, if applicable, and then to the plan of the parent who does not have custody and then to his or her spouse’s plan, if applicable.
Any amount unpaid by the “first” plan can then be submitted to the other plan (with appropriate documentation showing expenses submitted and what the “first” plan paid for each expense).
Also, note that you cannot be covered both as a Member and Dependent of this Plan at the same time, and if your status changes from Member to Dependent or vice versa, Plan maximums will apply on the basis that you are one person. Furthermore, coordination of benefits for eligible dependent children cannot be done within this Plan if you and your spouse are both members of the Plan.