Typically dentists can submit a dental claim electronically directly to the insurer. If not, the Employee can mail the claim form to the insurer for reimbursement of costs as per the group policy.
Employees can coordinate benefits with their Spouse. Both must be covered under their employer’s dental plan and at least one (Employee or Spouse) must have couple or family coverage.
- An Employee can never receive a refund of more than 100% of eligible expenses.
- Employees must submit claims for their expenses to their benefits program first. If the refund is less than 100% of costs, the Employee can then submit a claim for the difference to their Spouse’s plan.
- The Spouse must always submit claims for expenses incurred for himself or herself to his or her own plan first. If the Spouse’s refund is less than 100% of the expense, then the Spouse can submit a claim for the difference to the Employee’s benefits program.
- Claims for dependent children must go first to the plan of the parent whose birthday comes first in the calendar year. If the parents have the same birthday, submit the child’s claims to the plan of the parent whose first name comes first in the alphabet. If the parents are separated or divorced, the child’s claim must go first to the plan of the parent who has custody of the child.