How Does Co-Ordination of spousal benefits plan work?
In general, life and health insurance companies follow procedures which establish which plan pays first and how benefits are calculated when an individual makes a claim to more than one group plan, either as the plan member or a dependent under a spouse plan.
In families with two working adults, it is common to have access to more than one health or dental plan – this is in fact the most common type of overlapping insurance coverage. In other words, a person may be covered under his/her plan as well as a dependent under spouse plan.
Here is how it works.
If you are covered as a member under a plan, that plan will always pay before a plan that covers you as a dependent. In other words, you must submit the claim to your own plan first.
- If you have coverage with your employer plan and as a dependent with your spouse’s employer plan then your employer plan pays your claim first and your spouse’s plan pays your claim second.
Dependent Children Claims
- When both parents have plans and their children are covered under both as dependents, the plan of the parent with the earlier birth date in the calendar year pays first.
Example :Father’s birthday –October 11 and Mother’s birthday- September 21
In this case Mother’s plan pays first – Mother’s birthdate comes before Father’s in the
calendar year .