What is Coordination of Benefits (COB)?
Coordination of benefits is a method by which two or more carriers or plans coordinate their respective benefits so the total benefit paid does not exceed 100% of the total expenses incurred. The purpose of COB is to allow patients to receive the highest level of benefits that they are entitled to.
Coordination of Benefits (COB) is a process where insurance and managed care companies coordinate coverage and payment of medical services for Members covered under more than one plan. There are specific guidelines to determine which carrier is the primary payer and which is secondary, and to ensure that a Member does not receive more than 100% of the maximum allowable charges.
If you are enrolled in both a BCBSNC health plan and another group health plan, we may coordinate benefits with the other plan. Coordination of Benefits (COB) means that if you are covered by more than one insurance plan, benefits under one plan are determined and paid before the second plan’s benefits are determined and paid. The plan that determines benefits first is called the primary plan. The other plan is called the secondary plan. COB is explained in more detail in your Member Guide.
Coordination of benefits is used when a member is covered by more than one health benefits plan. The primary plan is responsible for the initial payment of the claim. The secondary carrier may be responsible for payment after the primary health benefits plan has paid its contracted amount. All provisions of the secondary plan would still apply, such as precertification and referral requirements. If these are not met, the secondary carrier is not responsible for payment of the claim, and the member may be billed for the balance. The combined benefits will not be more than the expenses recognized under these plans. • Why did I receive a Coordination of Benefit questionnaire and do I have to return it? Completion of the Coordination of benefits questionnaire is very important as it is our method of determining whether a member has any other coverage that might be primary in a given situation. A coordination of benefit questionnaire helps us to gather the information we need to determine t
A43.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 becoordinated between two contracts at the same Blue Plan, different Blue Plans or between a Blue Plan and another commercial carrier.
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)?
