How can a person claim a balance owing on a payment made by a spouse’s insurer?

This would only apply to employees whose spouse has family coverage under their own plan.  First of all, when enrolling a member who already is covered by their spouse’s plan, please ensure that coordination of benefits are set up.  If the employee has elected to also have family coverage, he/she can submit the unpaid amount of their spouse’s claim and have up to the balance paid for any eligible expense.  A copy of the Explanation of benefits from the primary carrier should be submitted.

My spouse and I are both covered under different insurance companies; who is the primary carrier for my dependant’s claims?

If an employee with coordination of benefits with their spouse’s plan has dependent children and the claims are for one of the children, the employee would submit the claim under the person with the earlier birth date in the year.

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