Mr. Henderson is covered by two group health plans: his own through ABC Corp, and his spouse's through XYZ Ltd. Both plans cover dental expenses. Last month, he incurred $800 in dental bills. His plan with ABC Corp has a 90% reimbursement rate for dental, and his spouse's plan with XYZ Ltd has an 80% reimbursement rate. According to coordination of benefits principles, what is the maximum total reimbursement Mr. Henderson can expect for his dental expenses?

Question: Mr. Henderson is covered by two group health plans: his own through ABC Corp, and his spouse's through XYZ Ltd. Both plans cover dental expenses. Last month, he incurred $800 in dental bills. His plan with ABC Corp has a 90% reimbursement rate for dental, and his spouse's plan with XYZ Ltd has an 80% reimbursement rate. According to coordination of benefits principles, what is the maximum total reimbursement Mr. Henderson can expect for his dental expenses?

Answer options: ✅ $800

• $720
• $640
• $1440

Correct answer: $800

Explanation: Under coordination of benefits, the total reimbursement from all plans combined cannot exceed 100% of the actual incurred expenses. Even though the primary plan might pay less than 100%, the secondary plan will cover the remaining eligible balance, up to the total expense amount.