How do I determine if my Guardian Dental plan is primary or secondary?

When an individual is covered by more than one Dental plan, the Coordination of Benefits (COB) provision allows a secondary plan to coordinate its payments with what the primary Dental plan paid.

Guardian Dental plans follow several guidelines when determining which plan is primary and which are secondary.

• When a plan does not contain a coordination of benefits provision, it is always primary.

• When all plans have coordination of benefits provisions, the rules to determine the order of payment are outlined below.

  Note: The first rule that applies is the rule to use.

General rules

• When the plan covers the person, other than as a dependent, such as an employee, member, subscriber, or retiree, the plan is primary.

• When the plan covers the person as a dependent, that plan is secondary.

Rules for a child covered under more than one plan

When a child is covered by more than one plan, the order of benefit determination is outlined below.

1. If the parents are married or are not separated (regardless if they had ever been married), or a court decree awards joint custody without specifying that one party must provide health care coverage, the plan of the parent whose birthday is earlier in the year is primary. If both parents have the same birthday, the plan that covers either of the parents longer is primary. If a plan does not have this birthday rule, then that plan's coordination of benefits provision will determine which plan is primary.

2. If the specific terms of a court decree state that one of the parents must provide health care coverage and the plan of the parent has actual knowledge of those terms, that plan is primary. This rule applies to claim determination periods that start after the plan is given notice of the court decree.

3. In the absence of a court decree, if the parents are not married, or are separated (regardless if they had ever been married), or are divorced, the order of benefit determination is listed below. 

   1. Custodial parent's plan

   2. Spouse of the custodial parent's plan

   3. Noncustodial parent's plan

Rules for active versus inactive employees

• When the plan covers a person as an active employee or as that person's dependent, the plan is primary. An active employee is neither laid off nor retired.

• When the plan covers a person as a laid-off or retired employee or as that person's dependent, the plan is secondary.

• When the plan does not have this rule, and as a result, the plans do not agree on the order of benefit determination, this rule is ignored.

Rules for plans under continuation of coverage

• When the plan covers a person as an active employee, member, subscriber, or retired employee or as that person's dependent, the plan is primary.

• When the plan covers a person under a right of continuation provided by federal or state law, the plan is secondary.

• When a plan does not have this rule and as a result the plans do not agree on the order of benefit determination, this rule is ignored.

Final rules

• The plan that covered the person longer is primary.

• If none of the rules determine the primary plan, the allowable expenses will be shared equally between the plans that meet the definition of a plan. However, the Guardian plan will not pay more than it would have paid if it had been the primary plan.