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Submitting Claims for a Dependent Child

The following example is for illustrative purposes only. Available coverage and claim limits may differ from your current level of coverage.

When submitting claims for dependent children remember - all claims (for glasses, prescription medicine, medical appliances, dental exams or procedures or any other covered benefit) for dependent children go through the plan of the parent who was born earlier in the calendar year. It does not matter which parent is older, only which one was born earlier in the year.

Jane and her husband John have vision coverage that provides $250 for eyeglass frames and lenses or contacts every twenty four months. Their son is getting new glasses at a cost of $350.

If the ASEBP Covered Member's Birth Date Occurs Earlier in the Year

If Jane was born earlier in the year, the claim for her son's glasses goes to ASEBP first.

  1. She sends a completed claim form and the original receipts (she takes some photocopies because she'll need them later). ASEBP adjudicates the claim and, in the example above, reimburses $250. ASEBP also provides Jane an Explanation of Benefits (EOB).
  2. John can then submit the remaining expenses to his benefit plan using a completed claim form, a photocopy of the receipt and the ASEBP Explanation of Benefits. John's plan will then adjudicate the claim and, in the example above, reimburse the outstanding $100.

If the Non-ASEBP Covered Member's Birth Date Occurs Earlier in the Year

If John was born earlier in the year, his benefit carrier is first payer and all claims for the children must go there before sending any outstanding balance to ASEBP.

Using the same example, because John was born earlier, the claim goes to his plan first:

  1. John submits a completed claim form, the original receipts and remembers to take copies. He will receive an EOB and a reimbursement of $250.
  2. Jane then submits a completed claim form, along with the EOB and a photocopy of the receipt to ASEBP to be reimbursed the remaining $100.

Please Note: As part of our ongoing effort to ensure that claims submitted by covered members are paid by ASEBP correctly, claims that are first sent to ASEBP when another carrier should be paying first will be returned to you for submission under the other plan starting September 1, 2004. Once the other carrier has paid its portion, any unpaid balance can be submitted to ASEBP.

Correct submission of claims will not reduce your reimbursement. It will help to ensure ASEBP is not over-paying for claims that are the responsibility of another plan. Referring to the situation described above, we can see in the table below that Jane and John are reimbursed the same amount.

Claim
Details

Cost/Reimbursement

ASEBP as 1st payer

ASEBP as 2nd payer

Total Charges $350.00 $350.00
ASEBP Pays $250.00 $100.00
Other Coverage Pays $100.00 $250.00
Total Reimbursement $350.00 (100% of the cost) $350.00 (100% of the cost)

Please note that, depending on what coverage is provided by your employer, and how much of that coverage you have used during the year, you may or may not have all the coverage mentioned here.