Your program has a Coordination of Benefits (COB) provision, which means that if you or any covered family members are eligible to receive benefits under more than one group dental benefits program, the benefits will be coordinated so that, when secondary, this Plan will pay the unpaid portion of the allowable amount up to the benefits that would have been payable under this Plan in the absence of other coverage. The COB provision does not apply to any personal, non-group insurance policies.

The following rules determine which plan is primary.

• If the other program does not have a COB provision, it is considered primary.
• When both programs have COB provisions:
• The program covering the patient as a subscriber is primary, and the program covering the patient as a Dependent is secondary.
• If the patient is covered under both group programs as a subscriber or if the patient is covered under both group programs as a Dependent, the program covering the patient the longest is primary, except:

For covered children of married parents:

• The program of the parent whose birthday occurs first during the calendar year is primary, unless this birthday rule does not apply to the other program. In that case, the COB provisions of the other program will be used to determine which program is primary.

For covered children of divorced or legally separated parents:

• If the court has decreed financial responsibility, the program of the parent who has financial responsibility for the child is primary.
• If there is no financial decree, the program of the parent with custody of the child is primary.
• If there is no financial decree and the parent with custody remarries, that parent’s program remains primary and the step-parent’s program is secondary.

If none of the above applies, the program that has covered the child the longest is primary.

If you or any family members are covered under another group dental benefits program and that program is “primary” (as explained above), you should file a claim with that insurer first. Then, when you receive an explanation of what the other insurer paid, include a copy of that explanation of benefits when you file a claim with the Claims Administrator. This will help speed up processing of your claim.

Please note that this is only a summary of the Plan’s Coordination of Benefits Provision, for additional details please refer to Part IX of the November 1, 2006 SPD.