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If you are covered by two different health plans, your provider may file the claim with both plans. Then the health insurers will decide which plan covers which expenses on the claim. This is called Coordination of Benefits. If there are instances where you need more benefits to cover your health expenses than your primary plan covers, the secondary plan may pay part of a claim or an additional amount toward the claim, based on its coordination of benefits rules.
Here are some examples of when coordination of benefits is needed:
Note: If you have Medicare and another plan, coordination of benefits is always used. Medicare may be either primary or secondary based on the Medicare coordination of benefits. Letting you insurer know you have Medicare up front will save you and your doctor time when it comes to filing claims.
Coordination of benefits helps:
At times, you may get a form in the mail, an email or a call from your insurer to set up the coordination of benefits so claims get paid correctly. You may also want to document any other coverage you have when your plan renews each year.
Even if you don’t have other coverage, you will need to let your insurer know. Sometimes claims will be held until coordinate of benefits is confirmed. That means the provider won’t be paid until primary and secondary coverage is confirmed.
If you have more than one health plan, check out the section of your benefit materials called Coordination of Benefits (COB) to learn how it works.
For more information, call the Customer Service number listed on your health plan's member ID card.
Originally published November 23, 2020; Revised 2021
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