Basic Law on Coordination of Benefits
Basic Law & Rules on #Coordination of Benefits
Benefits When You Have Coverage under More than One Plan
When Coordination of Benefits Applies
This coordination of benefits (COB) provision applies when a person has health care coverage under more than one Plan.
The order of benefit determination rules below govern the order in which each Plan will pay a claim for benefits.
The Plan that pays first is called the Primary Plan. The Primary Plan must pay benefits in accordance with its policy terms without regard to the possibility that another Plan may cover some expenses.
The Plan that pays after the Primary Plan is the Secondary Plan. The Secondary Plan may reduce the benefits it pays so that payments from all Plans do not exceed 100% of the total Allowable Expense. §1300.67.13 * UHC EOC
References & Links
More Explanations of #COB Coordination of Benefits
- Delta Dentals Explanation
- “Working Spouse Rule”
- Health Care Reform Dependent Coverage vs Spousal Coverage
- How about an HSA (Health Savings Account) rather than buying extra policies?
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Supplemental Plans, like Colonial & AFLAC
- There might be some cases where a COB provision is not allowed – like HIPAA policies for when COBRA ends.
- Individual Plans cannot have this clause per CCR California Code of Regulations 1300.67.13 BUT, they might require that you cancel other coverage. Blue Cross EOC Page 5
- With COBRA protections and HIPAA availability when you lose Group Insurance, it probably is no longer necessary to keep an individual plan, “just in case.” The extra premium, would probably be better spent on Life or Disability Insurance.
- Life Insurance does not have a co-ordination of benefits clause. They will ask on the application though if you have other coverage to prevent over insurance and to make sure there is insurable interest.
- See also Balance Billing
What if your doctor charges more than the negotiated rate? - Employer Dental & Individual Dental?
Technical Resources
- Subrogation if you get in an accident and someone else can be sued
- CA Insurance Code §10270.98 Group Health Insurance Co-Ordination of Benefits
