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 Jane was born earlier in the year, the claim for her son's glasses goes to ASEBP first.
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:
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.
ASEBP as 1st payer
ASEBP as 2nd payer
|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.