Departments & Programs,UW Health,Benefits,UW Health Open Enrollment,Physician Open Enrollment,Delta Dental,Resources

Coordination of Benefits

Coordination of Benefits - Departments & Programs, UW Health, Benefits, UW Health Open Enrollment, Physician Open Enrollment, Delta Dental, Resources

Traditional COB Non-Duplication COB
Plan Pays
Plan Pays
You Pay
Plan Pays
You Pay
Allowable charges of $130 with services covered at 80%
by both the primary plan and the secondary plan.
$104 $26 $0 $0 $26
Allowable charges of $1,600 with services covered at
50% by the primary plan and 80% by the secondary plan.
$800 $800 $0 $480 $320
Allowable charges of $4,000, with services covered
at 50% by both the primary plan and the secondary
plan. The primary plan has a $1,200 maximum and
the secondary plan has a $1,500 maximum.
$1,200 $1,500 $1,300 $300 $2,500
800.236.3713 www.deltadentalwi.com Wisconsin’s #1 dental plan
Delta Dental of Wisconsin
Coordination of Benefits (COB)
It’s not uncommon for an individual to be covered by two dental plans. This often occurs in situations where both spouses
are employed at workplaces that offer dental plans. When a person is covered by more than one dental plan, there needs to
be a coordination of benefits when the claim is processed.
The first determination is which plan is primary. Generally, your plan will be primary for you and your spouse’s plan will
be primary for your spouse. For your children, usually the plan of the parent whose birthday comes first during the calendar
year is designated as primary; the other parent’s plan is secondary. (For children in blended families, the rules can be more
complicated. Check with your human resources department for details about order of benefits in specific circumstances.)
Duplication of Benefits
Most plans utilize a Traditional Coordination of Benefits. After benefits have been determined under the primary plan, the
secondary plan will determine its allowable benefit and pay a benefit up to the full amount of the claim. See examples below.
Occasionally, the secondary plan has a Non-Duplication Coordination of Benefits. In these cases, it will not “duplicate”
benefits that were paid by the primary plan. See examples below.
Plans with traditional coordination of benefits are much more common than those with non-duplication. However, as
shown in the chart below, the difference can have a significant impact on your out-of-pocket costs. It may be advisable
to check with the respective human resources departments for your plan and your spouse’s plan to see which type of
coordination of benefits is used in each plan.
Note: These examples are for purposes of illustration only. They do not take into account deductibles, exclusions, specific contract
language, and other factors that may apply in the processing of claims under real-life circumstances.