Orchard - Unchanged

Coordination of Benefits (COB)

It is the responsibility of the member to provide PEHP with accurate COB information. When PEHP is the primary plan, its eligible benefits are paid before those of the other health benefit plan.

When PEHP is the secondary plan, its eligible benefits are determined after those of the other dental benefit plan and may be reduced to prevent duplication of benefits.

PEHP accepts electronic COB claims. If you need to send COB paper claims to us, an EOB is required with the claim to determine eligible benefits.

When a dependent enrolls on a second PEHP plan creating “dual coverage” that plan is subject to the six-month waiting period for prosthodontic, implant and orthodontic services. Eligible benefits will be adjudicated in the same order as any other coordination of benefits. Exception: The waiting period will be waived if previously satisfied with other continuous PEHP-sponsored dental coverage.

This does not affect treatment in progress provisions.