Project Description

Benefits Coordination

What you need to know

What is the coordination of benefits?

In the situation you and your spouse are both enroled on your own employee benefits plan, as well as each other’s, the order of payment is known as the Coordination of Benefits, and is established by insurance industry guidelines.

Two plans to choose from, and one claim to submit. Do you know whose plan pays for you, your spouse, or your dependents?

Coordinate benefits
with your spouse

When the claim is for you:
Your employer’s plan is always the primary plan; making your spouse’s plan the secondary plan.

You should first submit your claim to your primary plan, GroupSource. Once your primary plan has paid for your claim, you can submit any remaining unpaid balance of the claim to your spouse’s plan.

When the claim is for your spouse:
The plans are reversed. Their plan is their primary, and your GroupSource plan is their secondary.

Have more than one plan?
In the rare instance you are the primary plan member in more than one benefits plan, the plan in which you are active full time is your primary, and the other is your secondary.

Coordinate benefits
for your children

When the claim is for your children:
Always submit claims in the same order as you or your spouse would. Submit claims to your dependent’s primary plan first, and then any unpaid balances can be submitted to their secondary plan.

Whose plan is my children’s primary?
When you and your spouse are both enroled in separate benefits plans (that both provide family-level coverage for your dependent children), the parent whose month and day of birth occurs earliest in the calendar year (year of birth is not considered) is the primary plan holder for shared dependents.

What if we have the same birthday?
In the instance you and your spouse have the same month and day of birth, the primary plan is the plan of the parent whose first name begins with the earlier letter of the alphabet.