Coordination of Benefits:
Coordination of Benefits is a procedure for paying health care expenses when people are covered by more than one dental plan. The goal of coordinating benefits is to make sure the cost of the dental procedure is covered within the scope of the plans, without exceeding the amount of the actual bill.
If you are covered by two or more dental plans—usually because both you and your spouse receive coverage through work—your coverage will be coordinated.
For children covered by both parents’ (or guardians’) dental plans, the primary carrier is determined by the “birthday rule.” The plan that covers the parent or guardian whose birthday comes first in the calendar year will be considered the primary carrier. The birthday rule may be superseded by a divorce judgment or court ruling.
If a dependent, such as a spouse or child, has dental coverage through a company other than Delta Dental and that company does not cover the full cost of a dental visit or procedure, your dependent may be eligible to receive reimbursement for part or all of the coverage from Delta Dental, provided that your dependent is also covered by your plan.
Explanation of Benefits:
An Explanation of Benefits (EOB) is a document that Delta Dental may send you after you receive dental treatment. This document will explain what procedures were covered under your benefits plan, as well as any procedures that might not have been covered, and why they were not covered.
An EOB will provide you with the information you need, including:
- Dental services performed (procedure description)
- Dentist fees
- Delta Dental’s payment
- Your required payment
- Coordination of benefits information, if applicable
- Annual maximums used in the current benefit year
EOBs are mailed directly to you, except when you do not owe a balance. If you do not owe a balance on the cost of your dental procedure, you can access a copy of your EOB online using the Member Portal.
By signing up for electronic delivery of EOBs through the Member Portal, you can stop the delivery of paper EOBs.
If you have questions about an EOB, give us a call at: (800) 662-8856.