<P>10© 2009 AAPD All rights reserved. 6. Will the plan provide bene?ts to patients who may also be covered by another dental plan? It is not unusual for employees to be eligible for dual bene?ts. That is, an employee/dependent may be covered under one companys plan as well as under that of his/her other parent/spouses employer. In analyzing options, make sure to look for a plan that allows coordination of bene?ts. As with all plan information, the AAPD believes that applicable Coordination of Bene?ts (COB) provisions should be clearly de?ned and described in employee bene?t booklets and available on carrier Web sites. COB is governed by state insurance law when the medical or dental plan is a regulated carrier. While insurance law can vary from state to state, most states follow a model adopted by the National Association of Insurance Commissioners. With the growth of employer-sponsored medical and dental plans and collectively bargained plans that operate under the federal Employee Retirement Income Security Act (ERISA) plans, the variability in COB clauses has expanded. A provision called non-duplication has also been added to some ERISA and other plans. De?nition of a primary carrier ? The plan covering the patient, other than as a dependent, is the primary plan. ? When both plans cover the patient as a dependent child, the plan of the parent whose birthday occurs ?rst in a calendar year should be considered as primary. ? When a determination cannot be made in accordance with the above, the plan that has covered the patient for the longer time should be considered as primary. ? When one of the plans is a medical plan and the other is a dental plan, and a determination cannot be made in accordance with the above, the medical plan should be considered as primary. When carriers are licensed by the state, state COB regulations provide guidelines by which the primary carrier and secondary carrier(s) are determined. Contact the National Association of Dental Plans at http://www.ada.org/prof/resources/ pubs/adanews/images/080505bene?tstable01.pdf for a chart that helps determine which carrier to bill ?rst. </p> <UL><LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/1/1/">Front-Cover</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/2/2/">Inside-Front-Cover</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/3/3/">Page-3</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/4/4/">Page-4</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/5/5/">Page-5</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/6/6/">Page-6</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/7/7/">Page-7</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/8/8/">Page-8</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/9/9/">Page-9</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/10/10/">Page-10</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/11/11/">Page-11</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/12/12/">Page-12</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/13/13/">Page-13</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/14/14/">Page-14</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/15/15/">Page-15</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/16/16/">Page-16</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/17/17/">Page-17</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/18/18/">Page-18</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/19/19/">Page-19</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/20/20/">Back-Cover</a></LI> <LI><a href="http://www.stallionpublishers.com/publications/1603/x/sitemap.xml" target="_blank">site map</a></LI> </UL>

 

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