What is Coordination of Benefits (COB)?
Coordination of Benefits (COB) is the anti-duplication provision to limit benefits for multiple group health insurance in a particular case to 100% of the covered charges and to designate the order in which the multiple carriers are to pay benefits. Under a COB provision, one Plan is determined to be primary and its benefits are applied to the claim. The unpaid balance is usually paid by the secondary Plan to the limit of its liability. Benefits may be coordinated between two contracts at the same Blue Plan, different Blue Plans or between a Blue Plan and a commercial carrier.
A51.Coordination of Benefits (COB) is the anti-duplication provision to limit benefits for multiple group health insurance in a particular case to 100% of the covered charges and to designate the order in which the multiple carriers are to pay benefits. Under a COB provision, one Plan is determined to be primary and its benefits are applied to the claim. The unpaid balance is usually paid by the secondary Plan to the limit of its liability. Benefits may be coordinated between two contracts at the same Blue Plan, different Blue Plans or between a Blue Plan and a commercial carrier.
Coordination of Benefits is the provision that applies when an enrollee is covered by two health plans at the same time. The provision is designed so that the payments of both plans do not exceed 100% of the allowed charges. The provision also designates the order in which the multiple health plans are to pay benefits. Under a COB provision, one plan is determined to be primary and its benefits are applied to the claim first. The unpaid balance is usually paid by the secondary plan to the limit of its responsibility. Benefits are “coordinated” between the two health plans.
A Member may be covered under more than one health plan. For example, you and your children may be covered under this Plan and under a group health plan sponsored by your spouse’s employer. If this type of duplicate coverage occurs, and you follow the rules of this Plan, including but not limited to PCP approval, this Plan uses a method called Coordination of Benefits (COB) to determine which plan pays first (is primary) and which plan pays second (is secondary). Under COB, total payments from both plans may provide up to 100% coverage for services provided.
Coordination of benefits is process to determine which plan has responsibility for payment when you are covered by more than one health plan. Heres how it works. Your primary plan is responsible for the initial payment of a claim. Your secondary plan may be responsible for an additional payment after the primary plan has paid its required amount. All provisions of your secondary plan would still apply, such as precertification and referral requirements. If these are not met, your secondary carrier may not make a payment, and you may be billed for the balance. Please note that the total amount of your health plan coverage would not be increased by Coordination of Benefits. Under this system, payment for your covered expenses is simply shared between two different health plans.
Related Questions
- Coordination of benefits (COB) is confusing. Can you provide some examples for dual coverage with medical plans so I can get a better understanding of how benefits will be coordinated?
- May carriers deny or pend claims on the basis of coordination of benefits (COB)?
- What are coordination of benefits (COB)?
