Other Important Information
Coordination of Benefits

For Dental and Vision Care Coverage
If you have dental and vision care coverage through your spouse's employer or another source, and have coverage through the School District's plan, a provision known as Coordination of Benefits may apply. This is to ensure that your combined benefits will not be more than the expenses recognized by both plans. Your benefits from the other plan will be taken into account when your benefits through the School District are determined. Coordination of benefits does not apply to any individual policy you have.

Other sources that provide benefits include the following:

• Government plan except for Medicaid
• Any group coverage (whether insured or not)
• Motor vehicle no-fault coverage

The following guidelines determine which plan pays benefits first:

• The plan covering you as an active employee of the School District pays first
• For dependent children, the plan of the parent whose birthday comes first in the calendar year pays first, unless the parents are legally divorced or separated
• If the parents are legally divorced or separated, the benefits for the child are determined as follows (except when a court decrees otherwise):
  • First, the plan of the parent with legal custody pays
  • Then, the plan of the spouse of the parent with legal custody pays
  • Finally, the plan of the parent without legal custody pays
• If you are receiving continuation coverage under the School District's plan, and you are also covered under another plan, the other plan pays first
• If the other plan does not agree with the School District's plan on the order of benefit payment, the rule of the other plan will prevail
• If none of the above apply, the plan that has covered the individual for the longest time pays first

If the claims administrator determines that payments exceed the coordination of benefits provision, the administrator has the right to recover the overpayment from the other insurance company, the other plan sponsor, or you.

There is an exception to this policy in the case of vision benefits. If both you and your spouse are covered under each other's vision benefits, you can receive benefits under both plans. The Coordination of Benefits will not apply.

If the claims administrator determines that payments exceed the coordination of benefits provision, the administrator has the right to recover the overpayment from the other insurance company, the other plan sponsor, or you.

For Prescription Drug Coverage
The Coordination of Benefits provisions also apply if you have prescription drug coverage through another source. If your additional coverage is provided through a source other than the State plan, the guidelines shown above for dental benefits determine which plan pays benefits first. If you are enrolled in the School District's supplemental plan and the State's medical plan, either plan can be used at any time provided you do not exceed the annual maximum benefit amount.

By using the School District's plan up to the maximum benefit allowed for generic equivalents, you can reduce the amount you pay out-of-pocket. The following guidelines help you determine which plan pays the greater benefit.

If you have exceeded the $2,000 or $10,000 annual maximum under the School District's plan, submit your prescription drug expenses to the State's medical plan, which has an unlimited maximum benefit amount. You will be responsible for a copay as follows:

If you have not exceeded the $2,000 or $10,000 annual maximum under the School District's plan, determine which plan best meets your needs. Under the School District plan, you will be responsible for a copay as follows: