(National Freight Railroad Contract and Amtrak Employees)
The change applies only where Aetna is the secondary payer and the primary payer is another plan.
An audit of the National Dental Plan late last year revealed that Aetna was administering the coordination of benefits (COB) provision incorrectly when it was the secondary payer and the primary payer was another plan. As a result, effective January 1, 2009, Aetna began applying the COB provisions as spelled out in the Plan SPD.
Before the error was discovered, Aetna had been paying 100% of its reasonable and customary rate, minus the amount paid by the primary policy. The correct method is for Aetna to pay the difference, if any, between the primary plan’s benefit and what Aetna would have paid if it had been primary. If the Aetna benefit is the same or less than the primary plan’s benefit, Aetna pays nothing, as provided for in the SPD.
This change does not apply where a husband and wife are both covered by the National Dental Plan.
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