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Dentovio public answer
Under the birthday rule, when a dependent child is covered by both parents' dental plans, the plan of the parent whose birthday — month and day, not year — falls earlier in the calendar year pays first. If both parents share the same month and day, the plan that has covered the parent longest is primary. A court decree assigning responsibility for the child's health coverage overrides the birthday rule, and self-funded employer (ERISA) plans can follow a different order-of-benefits rule set by the plan document. The rule comes from the NAIC Coordination of Benefits Model Regulation as adopted into state law; the adopted state text and the plan documents control the actual order.
Dentovio is an independent publisher, not an insurance carrier, benefits administrator, the ADA, or any government agency. These pages describe how the two most common coordination-of-benefits methods and the birthday rule work in general terms; the plan documents and each state's adopted COB rules control the actual order and amounts, and a self-funded employer plan is generally governed by ERISA rather than those state rules. Educational reference only — not legal, benefits, or billing advice; confirm the order of benefits and the secondary plan's coordination method with each carrier before quoting a patient.
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