Glossary of Terms
Delta Dental logo
 
Getting Started My Costs My Benefits
My Dentist Claims Policies/Legal Enroll/Renew
 
My Benefits
 
 

Continuity of Care
Benefits, Limitations and Exclusions
Emergency Services
Specialist Services
Coordination of Benefits
Renewal and Termination of Benefits
Cancellation of Enrollment
Schedule A
Description of Benefits and Copayments

Schedule B
Limitations and Exclusion

 
 
 
COORDINATION OF BENEFITS  
 

This Program provides Benefits without regard to coverage by any other group insurance policy or any other group health benefits program if the other policy or program covers services or expenses in addition to dental care. Otherwise, Benefits provided under this Program by specialists or Out-of-Network Dentists are coordinated with such other group dental insurance policy or any group dental benefits program. The determination of which policy or program is primary shall be governed by the rules stated in the Contract.

When this plan is secondary, it may reduce its Benefits so that the total Benefits paid or provided by all plans during a claim determination period are not more than 100 percent of total Allowable Expenses. "Allowable Expense" is defined as a service or expense, including deductibles and Copayments, that is covered at least in part by any of the plans covering the person.

An Enrollee shall provide to Delta Dental and Delta Dental may release to or obtain from any insurance company or other organization, any information about the Enrollee that is needed to administer coordination of benefits. Delta Dental shall, in its sole discretion, determine whether any reimbursement to an insurance company or other organization is warranted under these coordination of benefits provisions, and any such reimbursement paid shall be deemed to be Benefits under this Contract. Delta Dental will have the right to recover from a Dentist, Enrollee, insurance company or other organization, as Delta Dental chooses, the amount of any Benefits paid by Delta Dental which exceeds its obligations under these coordination of benefit provisions.

 
 
 
 
HIPAA Notice of Privacy Practices | Web Site Privacy Notice
© 2006 Delta Dental