Many working couples have coverage under more than one benefit program or you may even have another plan through another employer. If this is the case for you, you may be able to claim some expenses from both plans. For example, if you need dental services that cost more than the amount allowed by the Local 873 plan, you may be able to submit a claim for the extra amount to your spouse’s/other employers plan. There are certain rules you must follow so the outline below will help you to get the best possible reimbursement and ensure that each plan pays its fair share of the cost.
First, you need to check to see if the other plan has rules about claiming from more than one plan. Then, make your claims as follows:
Coordinating claims with your spouse
You receive treatment:
- Make your first claim to your Local 873 plan.
- Claim for anything left unpaid to your other plan/spouse’s plan.
Your spouse receives treatment:
- Spouse makes first claim to his or her own plan.
- Claim anything left unpaid to Local 873 plan.
Coordinating claims for your children
If you are living with your child’s other parent:
- Claim first to the plan of the parent whose birthday comes earlier in the year.
- Claim for anything left unpaid to the plan of the parent whose birthday comes after.
If you are separated or divorced – Make claims for each child in this order:
- To the plan of the parent with custody.
- To the plan of the spouse of the parent with custody.
- To the plan of the parent not having custody.
- To the plan of the spouse of the parent not having custody