Office of Management and Budget : Statewide Benefits Office

SPOUSAL AND DEPENDENT CHILD COORDINATION OF BENEFITS



SPOUSAL COORDINATION OF BENEFITS


If you cover your spouse in one of the State of Delaware's Group Health Insurance medical plans; you MUST complete a new Spousal Coordination of Benefits form each year during Open Enrollment and anytime their employment or insurance status changes.

Documentation and Forms

Who Pays First? (Spousal Coordination of Benefits Primary/Secondary Coverage Charts)
Look here for examples showing which plan is primary (pays first) when active or retired State of Delaware Group Health Insurance Plan (GHIP) members and spouses have more than one health care coverage.

IMPORTANT INFORMATION:
IF YOUR SPOUSE IS COVERED BY A HIGH DEDUCTIBLE HEALTH PLAN THAT INCLUDE A HEALTH SAVINGS ACCOUNT


DEPENDENT CHILD TO AGE 26 – COORDINATION OF BENEFITS

Beginning July 1, 2014, the State of Delaware Group Health Insurance Program (GHIP) will no longer administer the Dependent Coverage to Age 26 Policy. State employees, pensioners, and employees of participating groups may cover their dependent children to age 26 in their State health care plan, dental plan and/or vision plan with no restriction on marital, employment, student, resident or tax status. Pursuant to the Group Health Insurance Program Eligibility and Enrollment Rules, an employee or pensioner's children are defined as sons, daughters, stepchildren and adopted children.

A Dependent Coordination of Benefits Form must be completed for each enrolled dependent child regardless of age upon request by the Statewide Benefits Office or the State of Delaware GHIP health care carrier. To ensure correct processing of health care claims, the form should be completed whenever a dependent child:

  • is enrolled for the first time in a State of Delaware GHIP;
  • is also covered under a health care plan through another parent;
  • is also covered under another health care plan as an employee;
  • loses or changes coverage through an employer or another parent.

Documentation and Forms

Who Pays First? (Dependent Child Coordination of Benefits Primary/Secondary Coverage Charts)
Look here for examples showing which plan is primary (pays first) when a dependent child has more than one health care coverage.

Section Manager: Brenda Lakeman

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Benefits Documentation

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Last Updated: Friday August 22 2014
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