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DENTAL COORDINATION OF BENEFITS - EHB UnitedHealthcare Medical / Non-UnitedHealthcare Dental

Additional information about UnitedHealthcare’s EHB Dental product.
 

  • Pediatric benefits are embedded in every medical plan  (one exception is RI where each client has a choice)
  • EHB plans share accumulators and out of pocket maximums
  • Subscribers will receive pediatric dental ID Cards
  • Coordination of benefits between your EHB and traditional plan, one claim submission when all dental is with UnitedHealthcare
  • The traditional family dental plan brings added value and automatically coordinates with the pediatric benefits included in the medical plan
 
How will the two plans coordinate benefits when an employee has pediatric coverage embedded in the medical policy and also has a separate dental plan?
If a pediatric member has both UnitedHealthcare medical and dental plans:
  • This scenario offers the greatest ease in coordination of benefits
  • These members enjoy the convenience of one dental claim submission process and one network and one customer care unit
  • Coordinated adjudication, payment and benefit tracking to ensure they receive the full benefits of both plans
  • Medical coverage will be primary
    • Out-of-pocket costs of dental services will be applied to the medical deductible and out-of-pocket maximum, even if services are reimbursed by the secondary dental plan
If a pediatric member has a UnitedHealthcare medical plan and another carrier’s dental plan or vice versa:
  • Final determination about whether Medical will be primary or secondary will be determined by which policy/carrier the member was enrolled in first
  • The information provided on the claim will begin to help the insurance carriers determine if the pediatric member is covered first by their medical plan or their dental plan
  • If the claim indicates that the member’s only coverage is under the UnitedHealthcare medical or dental plan, then we would process that claim in accordance with the plan benefit

Click below to find an example of both scenarios to further illustrate the above information. If you have any questions please call your FNA Broker Representative.

UnitedHealthcare EHB Dental Product